Utilization Review RN/Documentation Specialist - (Full-Time)

Conducts medical certification reviews for medical necessity for hospital patients and services. Uses nationally recognized, evidence-based guidelines approved by medical staff to recommend level of care to the physician, and to serve as a resource to the medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations, and documentation improvement opportunities. Utilizing strong clinical expertise, official coding guidelines, and in-depth knowledge of risk adjustment, the RN-CDS ensures that documentation accurately reflects the patient’s condition, supports appropriate reimbursement, and contributes to high-quality patient outcomes.