Reviews, obtains, and communicates Utilization Review data to payors within deadlines set forth by agencies. Coordinates denial appeal process. Screens, identifies, and obtains clinical information on inpatient/OBS accounts requiring certification. Performs AD-HOC certifications when identified need by admission nurse or admission coordinator. Coordinates denial appeal process. Communicates/Documents outcomes of certification. Coordinates and performs retrospective certification process. Initiates discharge planning referrals during initial review process, as appropriate. Graduate of an accredited school of nursing. Six (6) years clinical experience preferably in acute care setting. Registered Nurse in the State of Georgia. |
