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Registered Nurse - Utilization Review in Kenosha at Froedtert South

Date Posted: 11/15/2018

Job Snapshot

Job Description

Performs concurrent and retrospective clinical documentation reviews utilizing evidence based criteria, discharge indicators, and clinical judgment for all patients and payers. Strives to maintain and improve compliance of regulations as required by CMS and other regulatory agencies. Assists in maintaining and ensuring medical necessity compliance and revenue integrity, improving reimbursement, while optimizing hospital efficiency and decreasing clinical denials.

Education:Associate Degree in Nursing
Experience Required: 1 to 3 years
Certification/Licensure Required:
Licensure to be eligible to practice as a Registered Nurse (RN) in the State of Wisconsin and/or the State of Illinois based on job location assignment.
Current BLS and/or CPR certification from the American Heart Association or American Red Cross or the ability to obtain certification within 6 weeks of hire.
Knowledge, Skills, and Abilities Required:
-Graduate of an accredited nursing program.
-Three to five years of previous related experience preferred.
-Strong clinical background in acute care nursing preferred.
-Ability to work independently and be attentive to details, as well as work well as part of a team.
-General knowledge of CMS and regulatory requirements, case management philosophies and coding guidelines.
-Strong organizational, analytical, and interpersonal skills.
-Possess proficient computer and keyboarding skills with ability to utilize and achieve accurate use of related software.

Shift: Days
Hours: 80
FTE: 1.0
Location: Kenosha Medical Center
Froedtert South is a comprehensive regional healthcare system that has served southeastern Wisconsin and northern Illinois communities for more than 100 years. Froedtert South provides services primarily through the Kenosha Medical Center Campus and the St. Catherine’s Medical Center Campus and several other clinic locations.
Froedtert South is an Equal Opportunity Employer. Froedtert South does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment decisions are made on the basis of qualifications, merit, and business need.