Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

• KHN RN Utilization Management Onsite Liaison - 124100 General

  • Active participation in onsite Barrier teams
  • Responsible for communicating and collaborating with all necessary parties (Physician Advisors, Documentation Excellence Care Coordination, Physician Partners, UM Specialists etc.) and documenting all pertinent information in a timely manner within required hospital systems
  • Knowledge and application of federal, state, HFAP and Quality improvement regulations • Responsible for completing clinical review on all assigned patients and communicating the reviews on a timely basis to payors, as directed UM Leadership
  • Track, trend and report payor specific issues escalating to UM Leadership.
  • Collaboration with Physician Advisors regarding ongoing standardized education for our physician & APP partners
  • Participate in design of workflows and procedures to reduce incidence of denials in conjunction with UM Leadership.
  • Delivery of Code 44 notification; change in status to patients or designee, ABN (Advanced Beneficiary Notice), HINN (Hospital-Issued notice of Non-Coverage) and answering questions providing education as needed
  • The Utilization Management Specialist will perform utilization review functions for KHN hospitals
  • Travel required as needed between facilities
  • Other duties as assigned

   

  Job Requirements

  Minimum Education

  • BSN from an accredited school or Healthcare related BS required

  Minimum Work Experience

  • Requires two years’ experience in utilization management, case management, care coordination, clinical outcomes and/or clinical documentation improvement.
  • Five years clinical experience minimum, Critical care or ED experience preferred.

  Required Licenses

  • Registered Nurse
  • Graduate of accredited RN nursing program with a current unrestricted license to practice in Ohio