Utilization Review Nurse
2 weeks ago
The Utilization Review team is seeking a highly skilled Registered Nurse to ensure compliance with review processes for determining appropriateness of admission at our healthcare facility.
Responsibilities:
- Utilization Review, Utilization Management, Advocacy and Education
- Clinical Analysis and Data Management
- Clinical Care Management/Coordination
- Resource Management
- Transition Management and Denial Prevention
- Utilization Management
- Psychosocial Management
- Establish and review departmental metrics to ensure alignment with organization's mission, vision, and strategic plan
Qualifications:
Diploma or Associate's degree (ADN) required, Bachelor of Science in Nursing (BSN), or Master's of Science in Nursing (MSN) preferred.
Current, RN license required, Basic Life Support (BLS) training or retraining is required and must be maintained for the duration of employment.
3 years of acute RN experience required.
Prior Utilization Review experience preferred. Current knowledge of medical necessity guidelines for hospitalization status preferred.
