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Utilization Review Nurse

3 months ago

Corrales, United States University of New Mexico Full time

Utilization Review Nurse

We are seeking a qualified Utilization Review Nurse to join our team. In this role, you will be responsible for reviewing all admissions and continued stay to the hospital for medical necessity and managing insurance authorizations throughout the stay. You will coordinate all systems/services required for an organized, multidisciplinary, patient-centered care team approach and assure quality, cost-effective care for the identified patient population. The position is part-time with shifts that rotate as needed.

  • Conduct initial and ongoing assessments
  • Initiate disease management protocols
  • Determine and manage outcomes
  • Ensure continuity of care through discharge planning
  • Analyze variances
  • Develop collaborative relationships with other departments/services and community healthcare agencies
  • Assist the patient, family, significant others to set patient-centered goals
  • Develop comprehensive multidisciplinary plans of care
  • Promote effective communication among healthcare team members
  • Participate in orientation, continuing education of staff RNs and other healthcare team members
  • Participate in continuous quality improvement activities
  • Administer medication and treatment as needed
  • Write treatment plans and coordinate patient drug and procedure activities
  • Provide and coordinate nursing care of assigned patients
  • May facilitate group therapy and/or education sessions

Qualifications:

  • Graduate of nationally accredited nursing program
  • Licensure as an RN in the state of NM or as allowed by reciprocal agreement by NM
  • Current CPR certification for Healthcare/BLS Providers or Professional Rescuers within 30 days of hire
  • Minimum of one year of directly related experience
  • Bilingual in English and Keres, Tewa, Tiwa, Towa, Zuni, or Navajo a plus

Physical requirements of the role include light work, which entails exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently. The job setting may pose minor physical risks, dirt, dust, fumes, and noise. Our department encourages a proactive approach to patient safety, identifying and reporting/correcting environmental conditions and/or situations that may put a patient at undue risk. We seek enthusiastic candidates who are committed to ongoing professional development and improving patient outcomes.