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Utilization / Quality Review Nurse
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- Review includes pre-certification, admission, concurrent discharge and retrospective review on assigned accounts.
- Conducting pre-certification of admissions or potential admission utilizing established guidelines, determining appropriateness of admission.
- Obtaining provider information on pre-certification and concurrent review, maintaining positive working relationships with preferred providers and payors and generating reports related to the UR/QA activity.
- Directing patients to appropriate providers through the pre-certification and review activity and establishing methods of data collection and monitoring to reflect UR/QA activity.
- Establishes methods of data collection and monitoring to reflect utilization review and quality assurance activity.
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