Utilization Review Manager - Home Care jobs in South Dakota

Award Winning Health Care: Avera has been named among the nation’s 15 Top Health Systems, Forbes list of America’s Best-in-State Employers and Level 10 Most Wired Health Care Organization by CHIME.

Culture: Be part of a multidisciplinary team built on teamwork, with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

You Belong at Avera: Competitive pay, front-loaded PTO and options for free health insurance, sign-on bonuses, various shifts to fit your lifestyle and opportunities for career growth.

Avera is looking for a Registered Nurse (RN) – Utilization Review to join our team!

Job Summary

The Utilization Review RN reviews current admissions, stays that go beyond the approved days and retrospective inpatient and observation cases to determine accurate level of care determination based on primary and/or secondary insurance payment requirements. The position also reviews scheduled/booked surgical cases and compares the scheduled registration status with any inpatient only procedure lists for specific insurance companies and ensures registration status is changed based on insurance payment rules; they also obtain a signed inpatient order is on the account for all Medicare inpatient only procedure cases. The position collaborates with clinicians and financial team members including the Pre-anesthesia Department, Surgery Scheduling, Clinical Departments, physicians, payers, Patient Access, Health Information Management, and Case Management. Demonstrates a willingness to maintain awareness of the business of medicine and transitional healthcare changes including but not limited to value-based purchasing ,bundled payments, accountable care organizations and the readmission reduction program

Education and/or Experience

• Graduate from a CCNE or NLN accredited nursing program is strongly preferred. Graduate from an approved nursing program is acceptable.
• Bachelor's degree in nursing preferred.
• Four years related clinical experience and/or training preferred. Knowledge of hospital revenue cycle and the electronic health record strongly preferred.
• Minimum 1-3 years of related professional experience.

Certification, Licensure and/or Registration

• Licensed as a Registered Nurse in the State of South Dakota and/or meeting the requirements of Multi-state licensure is required.
• Professional certification preferred.
• Membership in a professional organization preferred.

Work Schedule

• Monday-Friday
• 80 hours per 2 weeks

Pay

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

• $29.50 - $44.25 per hour

What Makes Avera Special?