Remote Rn Utilization Review Nurse Jobs in Michigan

Employment Type:
Full timeShift:
Day Shift
Description:
Purpose
Work Remote Positon
The Nursing Support (NS) colleague (uncertified, certified, unlicensed, or licensed) provides safe, quality health care services & / or assistance to patients under the supervision & direction of a registered nurse or other designated health care professional in accordance with level of experience, education, policies & procedures.
Note: "patients" refers to patients, clients, residents, participants, customers, members
Essential Functions
Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
Work Focus: Performs clinical care activities (direct or indirect) for patients within the "scope of practice" laws & training received; Cares for patients safely by assisting in clinical care services or engaging in administrative activities (e.g., maintaining records or supplies) that enhance or improve coordination, preparation & flow of the care experience.
Process Focus: Knows, understands & incorporates basic or essential area of practice (document, coordinate, communicate) & training standards.
Communication: Uses clear, effective, respectful language & communication methods / means.
Environment: Performs work in a safe, engaging, & supportive manner; Influences the responsible use of resources; Accountable for continuous self-development & supporting the growth of others.
Maintains a working knowledge of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.
Functional Role (not inclusive of titles or advancement career progression)
NS IV - licensed: Licensed role (direct or indirect healthcare); Provides nursing interventions or clinical knowledge application in decision-making; Participates in the planning, implementation & / or evaluation of & solutions for care; Performs delegated focused / holistic care autonomously according to care plan; May administer medication & carry out the therapeutic treatment within scope of license (state & TH policy); Performs direct & essential care or supportive activities as part of an interdisciplinary team with a deeper understanding, including theoretical knowledge; Demonstrates a level of independence to perform activities with general oversight, through personal contributions, teamwork & initiatives to safely improve outcomes; Advocates for patients & informs / counsels patients & families about illness & care details; May serve as a knowledge resource, role model & mentor or lead / coordinate / supervise direct & essential care activities or role-based service responsibilities of unlicensed / licensed / certified healthcare professionals within licensed scope of practice.
Minimum Qualifications
High school diploma or GED; Completion of an accredited program associated with license. License in the applicable state(s) of engagement. Valid driver's license where required by assignment. Additional Qualifications (nice to have)
Registered Nurse, preferred
Training or experience according to assignment area
Nursing Support (NS) IV
Physical & Mental Requirements & Working Conditions (General Summary)
Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
• Exposure to interruptions, shifting priorities & stressful situations. Frequent
• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent
• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent
• Perform manual dexterity activities & / or grasping / handling. Continuous
• Ability to climb, kneel, crouch & / or operate foot controls. Occasional
• Use a computer / other technology. Frequent
• Sit with the ability to vary / adjust physical position or activity. Frequent
• Maintain a safe working environment & use available personal protective equipment (PPE). Continuous
• Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous
• Ability to provide assistance in the event of an emergency. Occasional

Direct Healthcare Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
• Lift a maximum of 30 pounds unassisted. Occasional
• Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional
• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
• Lift a maximum of 30 pounds unassisted. Occasional
• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
• Encounter a clinical / patient facing / hands on interactive work environment. Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Work outdoors with variable external environmental conditions. Occasional

Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)
(Pay Range: $32.5171-$48.7757)
Nursing Support (NS) IV
Addendum
Additional minimum qualifications

• Four (4) + years of nursing experience
• Must possess a demonstrated knowledge of revenue cycle & denial management functions.
• Knowledge of & experience in case management & utilization management.
• Customer service background is required.

Additional Preferred qualifications:

• Registered Nurse, preferred.
• Bachelor's degree, preferred.
• Two (2) + years of charge audit, managed care or comparable patient payment processing experience preferred.
• AAPC, AHIMA, CHRI certification/membership strongly preferred.
• Outpatient CDI experience preferred.
• Working knowledge of Electronic Health Records (EHR), preferred

Responsible for coordinating revenue integrity/ charge-related denials with Patient Business Service (PBS) center & ensures compliant & complete clinical documentation, assists with denials & related audits & identifies opportunities for revenue optimization.
Performs thorough and routine chart reviews, providing education to clinical colleagues & tracking of identified trends.
Leverages clinical knowledge & standard procedures to ensure timely attention to charge-related trends and provides necessary education to responsible party.
Responsible for retrospective charge reviews & assistance with third party charge audits. May require travelling between locations within the region.
Ensures tracking of all Revenue Integrity- related audits, identifying trends & collaborating with other Revenue Integrity, PBS & /or departmental colleagues on education & reporting to key stakeholders.
Serves as a resource contact, providing clinical information as requested by intra & inter-departmental colleagues & payers.
Collaborates with Revenue Integrity team on opportunities to improve & implement front-end process to support denial prevention.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.