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The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed by utilization review standards.
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Collaborates with Social Work, Utilization Review, Clinical Documentation Specialists, and others as necessary to maximize financial/care resources for patient and family. Job Summary Our Registered Nurse Care Coordinator Case Manager coordinates discharge planning that begins at the time of admission and is reevaluated and adjusted throughout the patient's hospital stay.
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Detailed knowledge of federal and state hospital Utilization Review (UR) regulations, Medicare Conditions of Participation, Medicare Guidelines regarding Medical Necessity, Hospital Admission and Hospital stays.
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Currently has or is able to achieve and maintain certification as a Certified Professional in Healthcare Management, a Case Manager, or Utilization Review/Utilization Management Professional as directed by IHSC through formal training and other means.
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Current knowledge of reimbursement requirements, level of care criteria, APR-DRGs, MCG guidelines Work hours: Evenings Education Requirements: Bachelors: Nursing (Required) Certification/License Requirements: [Lic] RN: Registered Nurse (RN) - Ohio Board of Nursing.
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FSH RN Discharge/Utilization Review Nurse. FSH RN Discharge/Utilization Review Nurse. Medical, dental, vision, healthcare/dependent FSA, life and disability insurance. Benefits such as paid holidays and vacation help you keep a healthy work-life balance.
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Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred. Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when appropriate.
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Responsible for the initial utilization review screen and the ongoing utilization review process through discharge. Join our team as a PRN, variable shift, Case Management, Registered Nurse in Tulsa, OK.
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Knowledge of insurance, utilization review, scheduling requirements and support of front desk responsibilities. ACLS Certification (Advanced Cardiac Life Support) - American Heart Association; AHA Basic Life Support for Healthcare Professional (AHA BLS Healthcare) - American Heart Association; California Registered Nurse (RN) - CA Board of Registered Nursing.
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Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Must possess strong critical thinking skills, have an ability to perform clinical/chart review and abstract information efficiently.
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The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the organizations mission and values. Title: RN Utilization Review II Description: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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Position Quality Review Nurse, RN Description Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for: - Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments.
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Sitting, walking, and/or standing for up to 90% of work time when doing Utilization Review, Preauthorizing Orthopedic and Urology surgeries and Mental Health Assessments, etc. Contacts patients to discuss authorization status and schedules a Pre-Admission visit with the Nurse Educator for all surgery cases.
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Additional experience in case management, quality, utilization review, transitional care, or post-acute services is helpful but not required. As a clinical performance nurse (CPN) with Sound’s hospitalist team.
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN.
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