Job Description Assumes responsibility for high level screening in regards to initial admission assessment and any ongoing concurrent assessment of designated patients as assigned; monitor level of care through communication with direct nursing care givers, care management team, physicians, patient and family members, and other members of the health care team. Ensures initial admission reviews are completed and submitted to payer in a timely manner, same admission day or within first working day of admission; obtain certified days for patient's presenting signs and symptoms and or documented primary diagnosis with treatment plan with the confirmation of level of care and admission status (patient type) appropriateness throughout the patient's hospital stay. Investigates with resolution of unauthorized clinical days and payment denials by payer for clinical services, same working day; front-end denial prevention prior to patient discharge. Assumes responsibility for the completion of the Medicaid process for patient admission, continued stay, discharge and or post-acute services approval. Works collaboratively with physicians to improve the overall quality of clinical documentation reflects the patient's presenting severity of illness for hospitalization, and to establish accurate assignment of patient status orders (observation, inpatient), concurrently, throughout the patient's hospital stay. MINIMUM REQUIREMENTS: Must have at least 2 years of recent hospital/managed care UR experience Must have 3-5 years of RN clinical experience Must have Interqual OR Milliman experience Must have completed BSN Company Description Guiding Principles Alignstaffing was founded over 15 years ago on the idea of bridging the divide between talented candidates in the education, healthcare and social services sectors, and the companies and institutions that need them. Our partnership with your organization allows you to focus your energies on what's most important. We understand the demands you face - time is crucial, and the right staffing, essential. Our experienced team of recruiters can save you that valuable time by always having staff available, credentialed and ready to assist. From his own personal experience as a young student in special education, alignstaffing's founder, Aaron Copeland, came to understand the importance of professionals in these fields, not only to the institutions they work for, but to the populations they serve. Alignstaffing is the premier staffing provider for education, healthcare, and social services in the Washington, DC area, including northern Virginia, Prince George's County, and Montgomery County. We are committed to being responsive and to aligning our services with your needs. It was the soul of the business 15 years ago and it remains so today. Our Guiding Principles Quality of life for our staff, clients, business partners and community. We recognize the human element of business. We see our staff, our clients, our partners and the community as individuals and people. We value quality of life at work as well as outside of work. Commitment to delivering an exceptional experience. We are committed to our clients' exceptional experience. We understand our clients' challenges, needs and goals. We have a high sense of urgency to deliver on our promises. Making our expertise a distinguishing value. We recognize that our clients require expertise. We aspire to become a trusted advisor. We strive to improve our expertise. Making the complex simple. We outsource everything we are not experts in. We stay within our core competencies. We strive to communicate succinctly, candidly and with transparency.