Utilization Review RN

4 weeks ago


Olney, Maryland, United States MEDSTAR HEALTH Full time
This position has primary responsibility for case management of patients and their families, coordinating and monitoring the quality of care and treatment planning process for the duration of their stay in the Hospital.
Case Management: Facilitates patient care by determining and reviewing ongoing medical criteria standards and benchmarks. Facilitates and effective transition for patients and their families. Coordinates patient's transition in accordance with utilization review guidelines and admission criteria, through the appropriate services. Communicates and consults with clinical and utilization review staff, regarding patient progress and movement through system. Updates patient and family situations daily. Plans for patient's discharge, making all necessary arrangements, contacts and completes placement prior to discharge. Meets with families on individual bases to prepare for discharge. Acts as a liaison between patients/families and other health care providers, agencies and payers. Responsible for patient/family education as well as staff education. Provides extensive clinical support to families in crises. Provides education to patients/families for continuing care options.Team: Acts as a departmental and hospital resource through informal leadership and technical expertise. Acts as a mentor to others on team. Participates in the orientation of new staff members, assists with supervision of students and volunteers as needed Provides education for hospital staff, including physicians, nurses, discharge planners, social service workers and others.Development: Maintains current knowledge, certification, and licensure. Identifies learning needs in self and initiates actions to address these education needs. Attends continuing education programs in order to maintain certification. Attends hospital sponsored training programs as required by the department. Assists in the development of new programs to improve quality of care and/or reduce unnecessary expenses. Completes all mandatory requirements, certifications, and licensure within allotted timeframe for completion (License, PPD, Competencies, Age Specifics, etc.)Organizational knowledge: Works effectively within and between departments. Participates on inter-departmental teams and committees, communicating unit knowledge as appropriate Provides department/unit with information and knowledge acquired during participation with interdepartmental teams and committees. Demonstrates a constructive approach during all interactions with staff, supervisors, and managers both inside and outside the unit.
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