Utilization Review Specialist RN

2 weeks ago

New Haven, Connecticut, United States Yale New Haven Health Full time

Overview:


To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values.

These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.


The Utilization Review Specialist (URS) performs utilization review activities as pertains to medical necessity of admissions for all patients in accordance with established guidelines, and stewards the process of ensuring regulatory and financial compliance of resource utilization, documentation and physician orders.

EEO/AA/Disability/Veteran

Responsibilities:

  • Functions as the liaison between various hospital departments, medical staff and payors on issues issues related to medical necessity for admission and continued stay.
  • The URS maintains open, transparent and clear lines of communication with the physician advisors.
  • Provides UM education to clinical staff as needed.
  • Applies standardized criteria and guidelines to assist in the determination of appropriateness of admissions and assignment of patient class (i.e. observation, inpatient and outpatient).
  • Assist in monitoring wasted resources while maintaining uncompromisingly high quality of care.
Responsible for maintaining and ensuring the admission process remains fully compliant with Medicare and Medicaid regulations.

  • Acts as a resource to Care Management department regarding utilization, insurance and payor issues.
  • Identifies potential problems regarding payment eligibility for clinical services and recommends corrective action.

Qualifications:

EDUCATION
Minimum of a baccalaureate degree in a clinically related field. RN required.

EXPERIENCE


Minimum of five (5) years of relevant clinical experience is required, with at least two (2) years of experience in case management, care coordination, utilization review, or disease management preferred.


LICENSURE
Current RN licensure in Connecticut

SPECIAL SKILLS


The applicant must have a high degree of familiarity with clinical care to establish credibility with physicians, LIPs, nurses and other members of the front-line care team.

The URS must have strong interpersonal and communication skills to manage competing priorities of the different stakeholders to ensure provision of high quality, high value and efficient care.

The URS will regularly interact with physicians and nurses, and must be able to assertively express oneself without antagonizing the other members of the interdisciplinary team.

The URS must have the ability to quickly process complex problems, identify key components, and develop plans for resolution. The applicant must be able to provide clinical and financial education to colleagues, patients and families. Critical thinking, negotiation and the ability to set priorities are of highest importance. Must be able to learn and use multiple computer systems.

  • Patient Service Specialist

    2 weeks ago

    New Haven, Connecticut, United States Select Medical Full time

    OverviewWhen patients enter our center in New Haven, we want them to have an exceptional experience - starting at the front desk. That's where you come in. As a patient service specialist, you'll manage both the patient side and business side of our center. The front desk is your station to be a patient advocate, communicate with individuals via email and...

  • Patient Financial Access Specialist

    2 weeks ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    Overview: To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.The Patient Financial Access Specialist - OP is responsible...

  • Sr. Diversity Equity Inclusion Training Specialist

    4 weeks ago

    New Haven, Connecticut, United States Yale University Full time

    Sr. Diversity Equity Inclusion Training SpecialistDiversity and Work Life - Diversity Administration88475BRUniversity Job TitleTraining Specialist IIBargaining UnitNone - Not included in the union (Yale Union Group)Time TypeFull timeDuration TypeRegularCompensation GradeAdministration & OperationsCompensation Grade ProfileManager; Program Leader (24)Wage...

  • Sr. Diversity Equity Inclusion Training Specialist

    1 month ago

    New Haven, Connecticut, United States Yale University Full time

    Sr. Diversity Equity Inclusion Training SpecialistDiversity and Work Life - Diversity Administration88475BRUniversity Job TitleTraining Specialist IIBargaining UnitNone - Not included in the union (Yale Union Group)Time TypeFull timeDuration TypeRegularCompensation GradeAdministration & OperationsCompensation Grade ProfileManager; Program Leader (24)Wage...

  • Metadata Specialist

    4 weeks ago

    New Haven, Connecticut, United States Yale University Full time

    DetailsPosted: 07-Dec-23Location: New Haven, ConnecticutType: Full-timeSalary: OpenInternal Number: 85614BR1. Creates and implements appropriate metadata strategies for digital projects, including analyzing metadata needs and developing workflows. 2. Performs analysis, remediation, and normalization of metadata in the library's online catalogs and discovery...

  • Metadata Specialist

    1 month ago

    New Haven, Connecticut, United States Yale University Full time

    DetailsPosted: 07-Dec-23Location: New Haven, ConnecticutType: Full-timeSalary: OpenInternal Number: 85614BR1. Creates and implements appropriate metadata strategies for digital projects, including analyzing metadata needs and developing workflows. 2. Performs analysis, remediation, and normalization of metadata in the library's online catalogs and discovery...

  • Metadata Specialist

    2 weeks ago

    New Haven, Connecticut, United States Yale University Full time

    DetailsPosted: 07-Dec-23Location: New Haven, ConnecticutType: Full-timeSalary: OpenInternal Number: 85614BR1. Creates and implements appropriate metadata strategies for digital projects, including analyzing metadata needs and developing workflows. 2. Performs analysis, remediation, and normalization of metadata in the library's online catalogs and discovery...

  • RN; Registered Nurse, Medicine 6-7

    4 weeks ago

    New Haven, Connecticut, United States tapwage Full time

    OverviewTo be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.As an integral member of the Yale New Haven Health System...

  • Travel Nurse RN

    2 weeks ago

    New Haven, Connecticut, United States LanceSoft Full time

    Job DescriptionLanceSoft is seeking a travel nurse RN Labor and Delivery for a travel nursing job in New Haven, Connecticut.Job Description & RequirementsSpecialty: Labor and DeliveryDiscipline: RNStart Date: 07/07/2024Duration: 13 weeks36 hours per weekShift: 12 hours, daysEmployment Type: TravelPerks: Medical & Health Insurance Benefits from First Day for...

  • Senior Regulatory Affairs Specialist

    2 weeks ago

    North Haven, Connecticut, United States Medtronic, plc Full time

    Author EU MDR Technical Documentation. Assist in keeping company informed of regulatory requirements in the EU. Participate on cross-functional teams, providing regulatory input in alignment with the EU MDR strategy Review Change Orders and assess re Regulatory, Senior, Surgical, Specialist, Technical, International, Manufacturing, Healthcare

  • Lab Support Specialist

    1 month ago

    New Haven, Connecticut, United States PerkinElmer Full time

    ResponsibilitiesTo be the first line of support for the scientific community; reporting any concerns and ensuring these are closed out in a timely fashion, i.e., acting as a single point of contact and helping ensure minimal disruption.Meet regularly with laboratory service providers to ensure open lines of communication and identify, review, and resolve...

  • Lab Support Specialist

    4 weeks ago

    New Haven, Connecticut, United States PerkinElmer Full time

    ResponsibilitiesTo be the first line of support for the scientific community; reporting any concerns and ensuring these are closed out in a timely fashion, i.e., acting as a single point of contact and helping ensure minimal disruption.Meet regularly with laboratory service providers to ensure open lines of communication and identify, review, and resolve...

  • Infusion Nurse; Registered Nurse

    2 weeks ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    OverviewTo be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. As an integral member of the Yale New Haven Health System...

  • RN, Student Health – Yale Health

    1 month ago

    New Haven, Connecticut, United States Yale University Full time

    Yale Health – Student Health 85369BRUniversity Job TitleRegistered Nurse 1, AmbulatoryBargaining UnitNone – Not included in the union (Yale Union Group) Compensation GradeAdministration & Operations Compensation Grade ProfileManager; Program Leader (23) Wage RangesClick here to see our Wage Ranges Searchable Job FamilyClinical, University HealthTotal #...

  • RN, Student Health – Yale Health

    2 weeks ago

    New Haven, Connecticut, United States Yale University Full time

    Yale Health – Student Health 85369BRUniversity Job TitleRegistered Nurse 1, AmbulatoryBargaining UnitNone – Not included in the union (Yale Union Group) Compensation GradeAdministration & Operations Compensation Grade ProfileManager; Program Leader (23) Wage RangesClick here to see our Wage Ranges Searchable Job FamilyClinical, University HealthTotal #...

  • RN, Student Health – Yale Health

    4 weeks ago

    New Haven, Connecticut, United States Yale University Full time

    Yale Health – Student Health 85369BRUniversity Job TitleRegistered Nurse 1, AmbulatoryBargaining UnitNone – Not included in the union (Yale Union Group) Compensation GradeAdministration & Operations Compensation Grade ProfileManager; Program Leader (23) Wage RangesClick here to see our Wage Ranges Searchable Job FamilyClinical, University HealthTotal #...

  • Outpatient Urology Nurse Coordinator

    2 weeks ago

    New Haven, Connecticut, United States Yale New Haven Health Full time

    Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. EEO/AA/Disability/Veteran Responsibilities 1. As...

  • Physician Assistant or Nurse Practitioner

    2 weeks ago

    New Haven, Connecticut, United States Hartford HealthCare Careers Full time

    JobSchedule:Full Time Job Shift: Shift 1Shift Details: Mon-Sun Enhanced Tuition Assistance and Higher Education Partnerships Voluntary benefits include student loan programs, home, auto, renters insurance, identity theft protection, legal services, low-interest loans, pet insurance and more Family care benefits through including emergency back-up care...

  • Travel Nurse

    2 weeks ago

    New Haven, Connecticut, United States Bluepipes Full time

    Triage is seeking an experienced Oncology Registered Nurse for an exciting Travel Nursing job in New Haven, CT. Shift: Inquire Start Date: 06/14/2024 Duration: 13 weeks Pay: $2841.9 / Week Travel Oncology RN | New Haven, CT Travel Nursing: Oncology New HavenLocation: New HavenStart Date: 6/14/2024Shift Details: 12H Nights (7:00 PM-7:00 AM) 48 hours per...

  • Travel Nurse

    2 weeks ago

    New Haven, Connecticut, United States Triage Full time

    Triage is seeking an experienced Telemetry Registered Nurse for an exciting Travel Nursing job in New Haven, CT. Shift: Inquire Start Date: 07/12/2024 Duration: 13 weeks Pay: $2841.9 / Week Travel Telemetry RN | New Haven, CT Travel Nursing: Telemetry New HavenLocation: New HavenStart Date: 7/12/2024Shift Details: 12H Nights (7:00 PM-7:00 AM) 48 hours per...