RN UTILIZATION REVIEW LEAD

EXPERIENCE DESCRIPTION: Five (5) or more years acute care nursing experience, required. Two (2) or more years UR experience in an acute hospital setting, required. Utilization of Interqual, MCG care web QI or Indicia evidence-based guidelines, required. EDUCATION DESCRIPTION: Professional knowledge of nursing theory and practice at a level normally acquired through completion of a program at an accredited School of Nursing is required. Bachelor’s Degree in nursing is preferred. SPECIAL SKILLS DESCRIPTION: Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission, working DRG, and some familiarity with hospital coding. Ability to read and correlate an extensive variety of medical / surgical medical treatments and monitoring to clinical conditions. Requires excellent observation, negotiation, verbal and written communication and presentation skills, analytical thinking, and problem-solving skills. Requires strong interpersonal skills including ability to interact with all levels of organization including executive leadership and develop strategies to present to senior leadership. Efficient use of MS Office products (Excel, Outlook, Word), WebEx and Epic (or similar EMR). Advanced knowledge of reporting, statistical principles, and processes. Expert knowledge payer trends and rules Expert knowledge of level of care guidelines Ability to document and maintain process documentation. Excellent follow-through from initiation to conclusion. LICENSURE DESCRIPTION: Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). MCG certification is required. Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.

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