Inpatient Utilization Review RN - Night Shift
Utilization Review Nurse Job Summary:
Utilization Review Nurse Background:
- The nurse plays an integral part in the coordination of care for patients and providing them the necessary resources, options, and coordination for a healthy care outcome.
- The Utilization Review Nurse is responsible for utilization management or prior-authorized treatments, and the utilization review of concurrent patient treatment.
- The Utilization Review Nurse will performs reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
- Utilize clinical skills to provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
- Shifts will typically be 8 pm to 4:30 am, with one weekend shift every 3 weeks.
- Current, valid, and unrestricted state Registered Nurse (R.N.) license.
- Requires a bachelor degree in nursing (BSN) or other healthcare related field.
- Certifications such as CPUR/CPUM/CPHM or CCM/ACM is preferred.
- At least 2 years acute care clinical nursing experience is required.
- Around 1-2 years of hospital utilization review, inpatient or outpatient case management, or discharge planning experience.
- Will consider some combination of experience in case management, discharge planning, or utilization management experience in the acute, sub-acute, home health setting or managed care environment.
- Knowledge of guidelines for Medicaid/Medicare and related state programs is a plus.
- Highly prefer prior experience using InterQual / Milliman / MCG criteria for medical necessity, setting and level of care, and concurrent patient management.
- Computer skills to include Microsoft Word, Excel, database use, and basic data entry.