Registered Professional Nurse III (60% FTE, No Benefits), Utilization Review 284835 (60753

Job DescriptionThe Registered Professional Nurse III is responsible for conducting clinical and appeals reviews of hospitalized patients’ progress to secure insurance authorizations and reimbursement for Hilo Benioff Medical Center. Performs retrospective chart reviews to overturn denials by demonstrating medical necessity in compliance with URAC standards. Utilizes established criteria (InterQual ISD-AC) and follows the hospital’s Utilization Review Plan. Demonstrates knowledge of patient growth and development across all age groups (infant to geriatric) to accurately assess and address age-specific care needs. The role may require working varied shifts, including weekends and holidays.REQUIRED QUALIFICATIONS:MINIMUM QUALIFICATIONS: To qualify, you must meet all of the following requirements. Please note that unless specifically indicated, the required education and experience may not be gained concurrently. In addition, qualifying work experience is credited based on a 40-hour workweek.EDUCATION: Graduated from an accredited school of nursing. While not required, graduation from an accredited nursing program with a Bachelor’s Degree is highly desirable.Evidence of the appropriate training (e.g. official transcript or diploma) should be submitted with the application to be given credit for education. A legible photocopy will be accepted. However, HHSC reserves the right to request an official copy.EXPERIENCE: One-half (1/2) year of professional nursing work experience, where the employee independently provided nursing care to patients in a clinic, hospital, or institution. Possession of the required number of years of experience will not in itself be accepted as proof of qualification for a position. The applicant's overall experience must have been of such scope and level of responsibility as to conclusively demonstrate that he/she has the ability to perform the duties of the position for which he/she is being considered.CERTIFICATION: Basic Life Support (BLS) in Health Care Provider (adult, child and infant) is required one (1) month after employment. Certification in Utilization Review preferred.LICENSURE: A valid State of Hawaii as a Registered Nurse is required. Evidence of licensure is required with the application.Company DescriptionAs the Big Island’s leading providers of inpatient and outpatient care, the East Hawaii Region of Hawai`i Health Systems Corporation (HHSC), consisting of Hilo Benioff Medical Center, Honoka'a Hospital, Ka′u Hospital, Yukio Okutsu State Veterans Home, East Hawaii Medical Group and East Hawaii Health Pharmacy, delivers a full range of services and programs. Our three hospitals include 290 beds and more than 1,900 employees. Our medical staff is comprised of 250 physicians, physician assistants and Advanced Practice Registered Nurses, representing 33 specialties. East Hawaii Health is our network of clinics offering primary and specialty care. Hilo Benioff Medical Center functions as a Level III Trauma Center, which includes the second busiest emergency room in the state, providing 24-hour care and serving more than 50,000 patients annually. Honoka'a Hospital and Ka′u Hospital are designated as Critical Access Hospitals. To learn more about the East Hawaii Region, please watch our Video Yearbook or visit www.hbmc.org, www.honokaahospital.org or www.kauhospital.org.Pre-Employment Health RequirementsOffers of employment will be contingent on successfully passing a pre-employment examination, which includes a drug screen and other regulatory medical requirements such as, but not limited to, a tuberculosis (TB) screen. The cost for drug screening and blood draw for QuantiFERON and Titers, shall be borne by the Hawaii Health Systems Corporation.Pre-Employment Assessments for External CandidatesAs part of the recruiting process for this position, external applicants (job applicants NOT employed by HHSC’s East Hawaii Region) are required to complete pre-employment assessments shortly after application submission. If you are not an employee of the East Hawaii Region of HHSC, you will receive an email containing assessment instructions. We ask that you complete the assessments within two days of receipt of the request. Equal Opportunity EmployerThe East Hawaii Region of Hawaii Health Systems Corporation is a drug free workplace and an Equal Opportunity Employer.Shift DetailsMust be available to work shifts, weekends and holidays as necessary based on hospital operations. Services are provided 24/7.

Salary : $66,080