Utilization Review Author

Overview:

An 8.5 hour work shift, with a 30 minute lunch break, is the standard working hours for employees. The schedule varies between 7:00AM and 12:00AM Eastern Time and is applicable throughout the seven days of the week.

Headquartered in Chicago, R1 is a top-rated healthcare revenue cycle management service provider, offering transformative solutions to healthcare providers with the help of advanced technology. The organization is accessible to clients across the United States and worldwide, with a dedicated team of employees in multiple locations. Besides, R1 is a publicly traded company with potential investment opportunities.

Our mission is to be the trusted companion to manage revenue, allowing healthcare providers and patients to devote attention to their essential responsibilities. We prioritize conducting ourselves to act in everyone's best interests - clients, patients, and our team. With our proven, scalable operating system, we support healthcare organizations, quickly driving sustainable enhancements to net patient revenue and financial flows while simultaneously decreasing operational expenses and enhancing the patient experience.

In addition to identifying cases for review, the Utilization Review Author will also provide recommendations for appropriate care plans.

Responsibilities:

• Utilize InterQual and MCG to perform medical screening reviews and subsequent assessments for patients requiring admission to determine the relevant level of care required on a clinical and evidence-based framework
• Acquire information from diverse medical documents to validate the precision of clinical data
• The established standards of productivity, timeliness, and quality must be adhered to meticulously in completing the first level nursing utilization review
• Effective communication skills are a must-have for customer service personnel, as they need to convey information in a manner that resonates well with the customers
• Undertake additional responsibilities as directed by departmental leadership to bolster departmental and organizational strategies and goals that may entail system testing, training, and other opportunities aimed at fostering growth
• Completing annual compliance and HIPAA training is an important responsibility that helps to promote a culture of compliance and protects the confidentiality and integrity of all sensitive information
• Participate in the educational opportunities and mandatory training provided by the organization, with the aim of enhancing the quality of service delivery

Required Qualifications:

• You must possess a Registered Nurse license that is currently active in your state of residency
• Those with at least two years of hospital-based utilization or case management experience within the last two years will be given preference for this position
• It is a requirement for candidates to have a minimum of three years of clinical nursing experience
• Providers who possess knowledge about the current Medicare rules regarding Utilization Review can offer better care to their patients
• Competent analytical skills, efficient organization and proficient time management strategies are essential tools for achieving success in virtually any job
• Presenting the talent to work solo with limited supervision
• Proficient in delivering messages through written and oral communication
• The meticulous clinical abstraction and attention to detail were truly noteworthy
• For this position, applicants with experience using InterQual and/or MCG are given preference
• To fill this position, one has to possess a willingness to work a schedule that could involve evenings, days, weekends, and holidays, with service hours available from 7:00am to 12:00am EST

In a healthcare environment that's perpetually changing, we rely on our collective knowledge to develop inventive solutions. As our workforce expands, we facilitate growth through fostering cooperative partnerships, collaborative teamwork, and the liberty to explore personal and professional interests.

Our company is passionate about providing our associates with unique opportunities to contribute, innovate, and create meaningful work that makes a difference in communities worldwide. Our culture of excellence propels customer success and raises the bar for patient care. Furthermore, we believe in the importance of giving back to the community, and as part of our commitment, we provide an attractive benefits package to our associates:

Don't worry about your healthcare needs with our comprehensive medical, dental, vision, and prescription benefits

Progressive workplace policies recognize the value of downtime, social engagement, and community spiritedness, and therefore allocate paid leave days, volunteering options, and special day off packages

An employer-funded retirement investment strategy that matches the employee's contributions to the retirement account

The company provides the benefits of life insurance, short-term disability, and long-term disability coverage, all of which are paid for by the employer

Many employees use tuition reimbursement programs as a way to advance their careers and improve their earning potential

Although parental leave is becoming increasingly common, not all companies or industries offer the benefit

R1 RCM Inc. (hereafter referred to as the Company) regards equal employment opportunities as a paramount concern. As such, the Company is dedicated to availing its practices, including recruitment, hiring, placement, advancement, compensation, benefits, training, discipline, and termination, to all individuals irrespective of their age, color, National origin, citizenship status, any physical infirmity or mental disability, physical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status regarding public assistance, veteran status, or any other attribute safeguarded by federal, state, or local law.

Our company is committed to providing a fair and accessible job application process for individuals with disabilities. Please call us at 312-496-7709 to request accommodations

See more at R1RCM.com to expand your understanding

The pay range for this job in the US is $20.91 - $38.39. The individual's salary is dependent on various factors, including job functions, position level, work experience, relevant education or training, and geographical location.

Understanding the Advantages of Working at R1

A healthcare setting that is continuously developing demands that we use our combined expertise to deliver original solutions. As part of a fast-growing team, we have the opportunity to gain knowledge and develop professionally by working together and pursuing our individual interests.

We understand the importance of work-life balance and we provide our employees with flexible work options that enable them to take care of their personal responsibilities while maintaining high performance at work:

• Health, dental, and vision benefits: We offer a one-stop-shop of health, dental, and vision benefits making it easier for you to focus on your health needs
• By providing paid time off, companies communicate to their workforce that they value their contributions, and recognize the demands and stresses associated with the modern-day work environment
• The employer's contribution to a 401K with company match adds up to the employee’s contribution, which maximizes the funds invested
• The organization offers a comprehensive benefits package, including company-paid life insurance, short-term disability, and long-term disability benefits
• Tuition Reimbursement
• Parental Leave

The Company aims to create an inclusive workplace that accommodates diverse backgrounds and perspectives.

We believe in providing equal opportunities to all job applicants, including individuals with disabilities who require reasonable accommodation to complete the application process. Reach out to us at 312-496-7709 to receive assistance.

By adhering to the California Consent protocol, employers can demonstrate their compliance with California privacy laws while collecting job applicant personal data

Visit R1RCM.com for additional knowledge

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