RN Utilization Review Specialist-Forrer Boulevard-Part-time Varied Shifts

Kettering Health is a not-for-profit network of nine hospitals, Kettering College, and over 160 outpatient facilities serving southwest Ohio. Patients have access to high quality maternity care, state-of-the-art cancer fighting technology, Ohio’s leading heart hospital, as well as revolutionary brain and spine surgery. With nearly 14,000 employees and 2,100 physicians, Kettering Health is committed to transforming the healthcare experience with world class health services for every stage of life. Kettering Health recently celebrated the 50th anniversary of Kettering Medical Center. As a faith-based organization we are dedicated to treating all patients with love and respect regardless of religious preference. Multi-denominational Spiritual Services are offered at the network every day. Registered professional nurse with education, knowledge and experience.

Role focuses on review of inpatient and observation admissions to ensure correct assignment of Admit status. Communicates concurrently and resolves medical necessity discrepancies with physicians and other hospital leadership as needed.

Responsible for completing clinical review on all assigned patients and communicates these reviews to payers.

Identifies potential or actual denials for admission or ongoing stay both during the patient’s hospital stay and post discharge.

Review and decide the validity of medical necessity payer denials. Submits payer denial appeals.

Participates in design of work flows and procedure to reduce incidence of denials.

Current unrestricted Ohio RN licensure, BSN required.

5 years clinical experience with 2 years case management preferred

Case Management certification preferred

Works independently

Familiar with MCG Care guidelines

Ability to adapt quickly to changing priorities and regulations

Experience with computers required. Experience with Microsoft applications and EPIC software preferred

Typing experience required

Requisition Number: 2020-25573 Shift: Varied Shifts Shift Time: varied hours External Company Name: Kettering Health Network External Company URL: http://www.ketteringhealth.org/ Street: 1050 Forrer Blvd. FTE: 64 Hours Per Pay Period/FTE 0.80