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Utilization Reviewer (RN)- Morristown (Hybrid)
1. Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care. 2. Performs daily surveillance of observation cases and works with PA discussing any barriers to progression of care or discharge. 3. Intervenes proactively to avoid denials or delays in authorization.4. Actively communicates information to other CM team members and interdisciplinary teams regarding progress or payer issues related to continued hospitalization and post-acute service associated with the patients discharge plan. 5. Refers cases and issues to Physician Advisors or Designees in compliance with department procedures with timely follow up as indicated6.
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