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Facility:Dayton Children's - Main CampusDepartment:Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review RN conducts medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, Joint Commission, CMS, and other agencies. Prospectively, concurrently, or retrospectively determines the appropriateness of inpatient, observation, and extended recovery services following review of relevant medical documentation and medical

guidelines and communicates information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource to the physicians, collaborates with the Care Manager in the development and implementation of the plan of care, and collaborates with the Denials team assisting to prevent concurrent and retrospective denials. The Physician Advisor role will support the Utilization Review RN for second level clinical reviews for cases that do not meet medical criteria, complex cases, appropriate level of care, Medicare cases as required, and the need for Peer-to-Peer reviews. Collaboration with Physician Advisor will support policy development, process improvement, and staff education related to clinical denial mitigation.

Department Specific Job Details:

Shift

+ Monday-Friday

+ 8am-5pm

+ Every 5th weekend on call rotation

Education

+ Completion of accredited RN program with current RN license in Ohio required

+ Graduate of an accredited BSN Nursing Program required

Experience

+ Two years’ experience required in the acute care setting, preferably in pediatrics.

+ Current knowledge of reimbursement requirements, level of care criteria, APR-DRGs, MCG guidelines

+ Exceptional oral and written communication skills

+ Proficiency in Microsoft Word, Excel, PowerPoint and Epic Systems preferred

Education Requirements:

Bachelors: Nursing (Required)

Certification/License Requirements:

[Lic] RN: Registered Nurse (RN) - Ohio Board of Nursing

At Dayton Children's we believe that each moment counts with our patients, families and with each other.

We are moving at a fast pace and are looking for the right talent for our team at Dayton Children's. We want people who embody our values and want to become a part of the Dayton Children's difference. If this is you, apply today!

Our values:

+ Safety--We make safety our first priority.

+ Compassion--We deliver compassionate, family-centered care to all we serve.

+ Ownership--We are the pediatric care experts and act knowing that every patient, visitor and the hospital is our collective responsibility.

+ Collaboration--We work collaboratively to care for children, their families and each other.

+ Innovation--We continuously innovate to make Dayton Children's even better today and into the future.

+ Equity -- We strive for an environment in which all feel welcomed, valued and fairly treated in order to reach their full potential.

Dayton Children’s is proud to be an Equal Opportunity Employer who values diversity and will not discriminate against minorities, women, protected veterans, individuals with disabilities, or on the basis of age, color, gender identity, national origin, race, religion, sex, sexual orientation or transgender status.