Review patient medical records and utilize clinical and regulatory knowledge and skills, as well as knowledge of payer requirements, to determine the reason that cases are denied and if an appeal is required.
New York State Registered Nurse License required.
BSN preferred.Minimum five (5) years experience in utilization review experience required.
Minimum three (3) years clinical nursing experience required.
Minimum two (2) years case management experience required.
Ability to collaborate with Patient Financial Services and health Information Management.
Good communication and problem solving skills.
Strong investigative, interpretative and analytic abilities.
Strong Excel skills.
Southampton Hospital, now known as Stony Brook Southampton Hospital, is a member of the Stony Brook Medicine healthcare system, combining the best of academic and community medicine. Located in the heart of the village of Southampton, two hours from New York City, it provides healthcare services to an ethnically and socio-economically diverse population of year round residents, second homeowners and vacationers. The population, about 75,000 in the winter months, increases sharply to more than 225,000 in the summer. Stony Brook Southampton Hospital was named a 2018 Long Island Top Workplace by Newsday, ranking 9th among large employers (defined as having 500+ employees).