RN, Utilization Review Flexi
1 week ago
Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization and quality management, and the management of clinical/financial resources as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical information documented from providers ensuring clinical data is substantial enough to meet medical necessity criteria and will facilitate the appropriate billing status. Essential Duties and Responsibilities These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned. + Demonstrates the knowledge base and essential psychomotor skills required to effectively carry out the job. + Demonstrates the ability to interpret, analyze, and apply relevant data to prioritize and determine a course of action appropriate to meet the patients' clinical needs. + Demonstrates effective communication and collaboration with culturally and professional interpersonal skills. + Demonstrates effective time management and the initiative to carry out job responsibilities in a timely manner. + Effectively assess, plans, implements and evaluates strategies that ensure the appropriate utilization of clinical resources and management of length of stay. + Meets all organizational requirements. Demonstrates initiative to establish and achieve personal and professional goals. + Demonstrates effective customer service behaviors as defined by the organizations mission, vision and values. + Attend required hospital-wide orientations, meetings, and in-services + Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care Other Job Responsibilities/Expectations include: + Using approved criteria, conduct admission and concurrent chart reviews for Medicare/Medicaid/and managed care payers within appropriate time frame to ensure appropriateness of level of care. + Refers cases failing inpatient medical necessity screening to physician advisor for level of care determination when indicated. + Monitor length of stay and other ancillary resources use on an ongoing basis. Identify opportunities for process improvement and recommend actions. Monitor and document on an ongoing basis, avoidable days. + Communicates following the chain of command regarding proper utilization of resources, physician concerns, length of stay activities. + Coordinate with the department in-house liaison to assure third party certifications when required. Provide information as required regarding denials/approvals. Expedite the peer-to- peer process through collaboration with physician and insurance companies. + Communicate denials, verbally and in writing to patients, family, physician as needed. + Interacts with patients and families to educate about level of care when necessary or indicated. + Delivers observation notices and notices of non-coverage as appropriate to beneficiaries. + Works with the interdisciplinary team to communicate level of care determinations. + On a concurrent basis, enter all pertinent data (UR and other areas as assigned) in data collections system as per policy/established process. + Participates in clinical performance improvement activities as needed and as assigned. + Works within the CMSA standards of practice. + Ensures compliance with CMS, State and other regulatory agencies. + Liaison between attending physician and physician advisor for level of care recommendations, order changes, etc. + Assess for appropriate unit of care delivery within hospital and makes recommendations to the treating physician. + Works with Revenue Integrity, HIM and other internal departments to ensure billing status is correct. + Employee must be proficient in his/her job responsibilities at the end of 90 days. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and Experience Minimum Required Education: RN required, Preferred Education: BSN preferred Experience: Greater than 3 years clinical nursing experience required. Utilization management experience preferred. Must be self-directed and possess critical thinking and excellent organizational skills. Certificates, Licenses, Registrations CM certification strongly desirable. CCM or ACM or any approved certification body required within 2 years of eligibility for the exam
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Clinical Pharmacist, Flexi
2 days ago
Chesapeake, Virginia, United States Chesapeake Regional Medical Center Full timeJob Title:Clinical Pharmacist, FlexiJob Description:We are seeking a Clinical Pharmacist to join our team at Chesapeake Regional Medical Center. As a Clinical Pharmacist, you will be responsible for ensuring safe provision of medications and other pharmaceuticals as needed for adequate patient care.The ideal candidate will have excellent clinical skills,...
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Utilization Review Travel Nurse
1 week ago
Chesapeake, Virginia, United States Medical Solutions Full timeWe're seeking a highly skilled Utilization Review Travel Nurse to join our team on a 13-week assignment in Chesapeake, Virginia.About the JobThis role offers an exciting opportunity to work as a Utilization Review Travel Nurse, providing high-quality patient care and contributing to the success of our clients.The successful candidate will have excellent...
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Clinical Pharmacist, Flexi
2 months ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummaryClinical pharmacists are responsible for ensuring safe provision of medications and other pharmaceuticals as needed for adequate patient care according to professional standards and practices. Additionally, clinical pharmacists monitor drug therapies, counsel patients, and advise medical providers and nursing staff concerning drug therapy.Essential...
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Clinical Pharmacist, Flexi
3 weeks ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummary Clinical pharmacists are responsible for ensuring safe provision of medications and other pharmaceuticals as needed for adequate patient care according to professional standards and practices. Additionally, clinical pharmacists monitor drug therapies, counsel patients, and advise medical providers and nursing staff concerning drug...
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Clinical Pharmacist, Flexi
5 months ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummaryClinical pharmacists are responsible for ensuring safe provision of medications and other pharmaceuticals as needed for adequate patient care according to professional standards and practices. Additionally, clinical pharmacists monitor drug therapies, counsel patients, and advise medical providers and nursing staff concerning drug therapy.Essential...
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Resp Therapist, Flexi
3 weeks ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummary The Respiratory Therapist provides a complete range of therapeutic care to patients requiring respiratory care services as ordered by a staff physician. Essential Duties and Responsibilities These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned. Perform respiratory...
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Care Partner I, Flexi
3 weeks ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummary The Care Partner I is responsible for assisting the Nurse in providing patient care. Activities are based on the unit's specific needs and are performed within the scope of education, training and experience of the Care Partner. General Patient Care/Procedures + Demonstrate accuracy in taking vital signs, measuring intake/output, and completing...
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Patient Safety Sitter, Flexi
4 weeks ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummary The Patient Safety Sitter participates in high-quality, patient-centered care by providing continuous observation and monitoring for high-risk patients. In collaboration with the patient care team, the Patient Safety Sitter ensures the patient environment is free of obstacles and minimizes risk of falls and accidental or intentional self-harm. The...
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Registered Nurse
2 weeks ago
Chesapeake, United States Sentara Full timeCity/StateChesapeake, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Home Care and Hospice located in Chesapeake has openings for Registered Nurses. The openings include Full-time Monday-Friday, Part-time weekend, and Flexi. The preferred candidate will have 2 years of medical surgical experience in bedside care. The RN is supported by...
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RN - Adult - Trach/Vent Care
2 months ago
Chesapeake, United States Maxim Healthcare Service Full timeMaxim Healthcare in Virginia Beach, VA is hiring for a Registered Nurse to work with Adult patients in the home setting. As a member of Maxim, you will have the opportunity to make a lasting impact, while providing safe and patient-centered care for G-tube, Trach & Ventilator needs. Apply now to hear more! Position Details: Salary - $35-$44 Locations -...
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RN - Adult - Trach/Vent Care
2 months ago
Chesapeake, United States Maxim Healthcare Services Full timeMaxim Healthcare in Virginia Beach, VA is hiring for a Registered Nurse to work with Adult patients in the home setting. As a member of Maxim, you will have the opportunity to make a lasting impact, while providing safe and patient-centered care for G-tube, Trach & Ventilator needs. Apply now to hear more!Position Details:Salary - $35-$44Locations -...
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RN Specialty
2 months ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummary The Registered Nurse (RN) is expected to provide excellent, clinically competent patient care by utilizing the nursing process of assessment, planning, intervention, implementation, and evaluation; and effectively interact with patients, significant others, and the other healthcare team members while maintaining standards of professional nursing....
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RN/ED Observation Unit
3 weeks ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummaryThe Registered Nurse (RN) is expected to provide excellent, clinically competent patient care by utilizing the nursing process of assessment, planning, intervention, implementation, and evaluation; and effectively interact with patients, significant others, and the other healthcare team members while maintaining standards of professional nursing. The...
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RN/ED Observation Unit
2 months ago
Chesapeake, United States Chesapeake Regional Medical Center Full timeSummary The Registered Nurse (RN) is expected to provide excellent, clinically competent patient care by utilizing the nursing process of assessment, planning, intervention, implementation, and evaluation; and effectively interact with patients, significant others, and the other healthcare team members while maintaining standards of professional nursing....
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Chesapeake, United States Aureus Group Full timeA Hospital located in the heart of Virginia Beach is in need of Med Surg RNs for 13 weeks. In order to be considered for this position, RN's must hold the following: BLS, and VA or Compact RN License. This facility is right off the coast. Enjoy the gorgeous Chesapeake Bay on days off and give the East Coast your time. Position: RN Specialty/Modality:...
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Chesapeake, United States Aureus Group Full timeStep Down RN needed in VA for 13-week contract. Contact Aureus today for more information and to apply!Position: RNSpecialty/Modality: RN-Step-downLicenses/Certifications: CPR/BLS (Basic Life Support), State License-RN-Virginia, ACLS (Advance Cardiac Life Support)Physical Abilities: From 50-100lbsTravel the country while you enhance your clinical skills,...
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Home Health RN Contract
4 hours ago
Chesapeake, United States Sunbelt Staffing Full timeJob DescriptionJob DescriptionMinimum 1+ years nursing experience required.We are currently hiring for a Home Health RN in Chesapeake, VA. This is a 13 week contract position available for qualified RNs. Please review the requirements below and upload your resume when applying.Requirements:Virginia (VA) Registered Nurse (RN) License or Compact RN license...
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Travel Nurse RN
2 months ago
Chesapeake, United States ICONMA, L.L.C. Full timeOur Client, a Healthcare company, is looking for Chronic RN (Dialysis) for their Chesapeake, VA location Responsibilities: The Client Healthcare Recruitment registered nurse (RN) is responsible for the delivery of quality patient care through the nursing process of assessment, diagnosing, planning implementation and evaluation. The RN is responsible...
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Travel Nurse RN
2 months ago
Chesapeake, United States ICONMA, L.L.C. Full timeOur Client, a Healthcare company, is looking for Chronic RN (Dialysis) for their Chesapeake, VA location Responsibilities: The Client Healthcare Recruitment registered nurse (RN) is responsible for the delivery of quality patient care through the nursing process of assessment, diagnosing, planning implementation and evaluation. The RN is responsible...
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Travel Nurse RN
3 months ago
Chesapeake, United States ICONMA, L.L.C. Full timeOur Client, a Healthcare company, is looking for Chronic RN (Dialysis) for their Chesapeake, VA location Responsibilities: The Client Healthcare Recruitment registered nurse (RN) is responsible for the delivery of quality patient care through the nursing process of assessment, diagnosing, planning implementation and evaluation. The RN is...
