Clinical Utilization Review Nurse

1 day ago


Bowling Green, Kentucky, United States Med Center Health Full time
Job Summary

We are seeking a skilled Clinical Utilization Review Nurse to join our team at Med Center Health. As a key member of our healthcare team, you will play a critical role in ensuring the quality and appropriateness of patient care.

Key Responsibilities
  • Conduct thorough reviews of patient medical data to assess medical necessity and appropriateness of admission and continued stay.
  • Collaborate with the patient care team to ensure accurate and complete medical record documentation.
  • Identify opportunities for improvement in healthcare resource utilization and develop strategies to address underutilization and overutilization.
  • Communicate effectively with physicians and other healthcare professionals to ensure seamless care coordination.
  • Participate in performance improvement initiatives to enhance the quality and efficiency of patient care.
Requirements
  • Three years of recent clinical Registered Nurse experience in a hospital setting required.
  • Case Management, Utilization Review, and/or Coding experience preferred.
  • Graduate of a school of nursing required.
  • Bachelor's degree in nursing or related field preferred.
  • Kentucky RN license (or RN license in a State recognized by the Kentucky Nurse Licensure Compact Act) required.
What We Offer

As a Clinical Utilization Review Nurse at Med Center Health, you will have the opportunity to work in a dynamic and supportive environment that values excellence in patient care. We offer competitive compensation and benefits packages, as well as opportunities for professional growth and development.



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