Travel Nurse RN
1 week ago
**Job Specialty:** Utilization Review
**Job Duration:** Not specified
**Shift:** 8 Hour Days
**Guaranteed Hours:** 40 hours per week
**Experience:** Not specified
**License:** Registered Nurse (RN)
**Certifications:** Not specified
**Must-Have:** Compliance with all CMS regulations
**Job Description:**
- Responsible for oversight, planning, direction, and coordination of Utilization Review (UR) services.
- Provides Utilization Review support, education, and guidance for UR RNs.
- Educates and directs Social Workers on relevant responsibilities.
- Leads multidisciplinary rounds as directed by management.
- Reviews medical records to determine medical necessity for inpatient or observation status.
- Identifies and escalates issues related to utilization to appropriate healthcare team members.
- Supports resource-effective measures and develops coordinated discharge plans with healthcare teams.
- Advocates for patient services and funding to meet care plan goals.
- Collaborates with Social Services for referrals to ensure best patient outcomes.
- Coordinates and monitors patient conditions and interventions.
- Communicates effectively with patients, staff, and other departments.
- Supports team in resolving difficult interactions and conflicts.
- Manages assigned patient area utilization management, clinical coordination, palliative care, and discharge planning.
- Works with Emergency Department staff to determine admission level of care.
- Participates in budget management and productivity tasks.
- Leads daily multidisciplinary care rounds and ensures safe discharge plans.
- Collaborates with various departments to review coding, utilization, and discharge issues.
- Builds positive relationships with post-hospitalization care organizations.
- Maintains external compliance and manages monthly scheduling as required.
- Assists patients in developing support systems and collaborates across healthcare teams to optimize outcomes.
- Negotiates with insurance case managers for efficient service use.
- Ensures documentation compliance and reviews clinical appeals.
- Facilitates new staff orientation and collaborates for departmental educational needs.
- Serves as a role model and change agent for the team.
- Performs additional related duties as required.
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