Utilization Review Nurse

2 weeks ago


Bremerton, Washington, United States Virginia Mason Franciscan Health Full time
Job Summary

This role is responsible for conducting thorough reviews of medical records to ensure that hospitalizations are warranted based on established criteria and critical thinking. The Utilization Review RN will work collaboratively with attending physicians, consultants, and care coordination staff to determine the appropriate status of patients.

Key Responsibilities
  • Conduct admission and continued stay reviews to ensure compliance with utilization review guidelines and hospital policies.
  • Collaborate with physicians, payers, and care coordinators to ensure timely communication and follow-up regarding review outcomes.
  • Engage with second-level physician reviewers to support appropriate status determinations.
  • Communicate the need for proper notifications and education in alignment with status changes.
  • Participate in performance improvement teams and programs to enhance the quality of care.
Requirements
  • Graduate of an accredited school of nursing.
  • Minimum two years of acute hospital clinical experience or a Master's degree in Case Management or Nursing field in lieu of one year experience.
  • Current licensure as a Registered Nurse in the state of Washington.
  • Preferred: Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification.
Benefits

Virginia Mason Franciscan Health offers a competitive compensation package, including health, dental, and vision benefits, FSA, matching retirement plans, paid vacation, adoption assistance, and annual bonus eligibility.



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