Job description

join our team and make a difference at a great community based hospital, Montefiore New Rochelle. The hospital is part of the Montefiore Health System, a premier academic health system serving more than 3 million people living in the New York City region and Hudson Valley. We have a fantastic opportunity for a Clinical Resource Nurse to join our staff.

Position Summary:

The Clinical Resource Nurse is responsible for managing all utilization management The CRN is a registered professional nurse who conducts concurrent and retrospective utilization review activities to maintain compliance with regulatory, ) Accurately reviews patient's clinical information, utilizing criteria to ensure that services provided are medically necessary and that reimbursement requirements are met. Accreditation and contractual requirements) Complete retrospective review within required time frame

Responsibilities include:

• Responsible for performing all inpatient clinical reviews for authorization from insurance companies
• Attend Daily Rounds
• Assist with PRI/Screen as needed
• Provide coverage as needed for department director
• Attend and provide leadership with the Utilization Review Committee.
• Monitors the ER board and works with ER staff/Clinical leadership to stop inappropriate admissions
• Collaborate and assist Denial Manager regarding insurance issues, appeals, and denials.
• Provide weekend phone coverage for department, as needed
• Available for departmental coverage on weekends.

Education and Requirements:

• New York state License for Registered Professional Nurse and current registration or valid permit to practice in new York state as an R.N.
• BSN degree preferred
• Minimum of one year of experience in Utilization review required
• PRI Certified
• Knowledge of InterQual/Millman for medical necessity
• Strong Analytical Skills necessary for problem solving and clinical decision making
• Expert Clinical knowledge of disease processes
• Understanding of managed care regulations required
• Experience with electronic health records
• Experience with Windows based software applications

We offer an excellent salary, comprehensive benefits package and free parking! EOE. We welcome diversity. Apply today and become a part of a supportive work environment where growth and development is encouraged.

Job Type: Full-time

Pay: Up to $111,000.00 per year

Benefits:

• Dental insurance
• Disability insurance
• Employee assistance program
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Physical setting:

• Hospital

Standard shift:

• Day shift

Weekly schedule:

• Monday to Friday
• Weekend availability

Ability to commute/relocate:

• New Rochelle, NY 10801: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Nursing: 1 year (Preferred)
• Utilization management: 1 year (Preferred)

License/Certification:

• RN License (Preferred)

Work Location: In person

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