Job Description

Job Title: UM RN Reviewer
Job ID: 690496
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: GL HH Administration
Location: 1700 Peach St, Erie PA 16501

Description

Purpose:
Provides direction and guidance to admission and clinical staff related to the overall functions of the Utilization Management department including but not limited to accurate, complete and compliant documentation.

Responsibilities:
  • Builds and mends relationships among colleagues within the framework of a healthy workplace
  • Role models keen cultural awareness including preventing and addressing horizontal violence and impairment
  • Maintains a conscious balance between work and personal life through prioritization and delegation of responsibilities.
  • Critically evaluate and provide direction and education related to utilization of services, diagnosis and teaching sheet selections on all comprehensive assessments
  • Review OASIS and 485 Plan of Care for accuracy and completeness and ensure correct coding assignment
  • Demonstrate knowledge of most recent COP's, PPS regulations and Joint Commission standards and ensure department compliance
  • Attend compliance training and adhere to the organization standards of conduct, policies and procedures
  • Identify, develop and participate in process improvement opportunities within the home health agency that will enhance the quality of the serviced provided
  • Identifies opportunities for clinical quality as well as workplace improvement
  • Applies evidence based practice as a regular aspect of professional practice
  • Serves on or leads teams that launch innovations in patient care or support a healthy workforce
  • Identify, investigate and recommend solutions to organization issues
  • Collaborate with clinical management to assist in identification and resolution of staff performance improvement areas and monitor and report upon progress

Qualifications

  • Graduate of accredited school of professional nursing required
  • BSN preferred
  • 2 years experience in home health required
  • 2 years utilization review experience preferred
  • Demonstrated proficiency in Medicare, Medicaid and commercial insurance regulations and in JCAHO standards required
  • Knowledge of ICD 9 coding required
  • Diagnostic coding experience preferred
  • OASIS experience preferred

Licensure, Certifications, and Clearances:
  • Act 33 Child Clearance
  • Act 34 Criminal Clearance
  • Act 34 Criminal Clearance
  • Older Adult Protective Services Act
  • Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $19.25 to $33.33

Union Position: No

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