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Nurse Utilization Review Specialist

2 months ago

Cliffside Park, New Jersey, United States VNS Health Full time
Job Title: Registered Nurse - Utilization Review

VNS Health is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will play a critical part in ensuring the highest quality of care for our patients.

Job Summary:

The Utilization Review Specialist will be responsible for conducting clinical assessments, collaborating with healthcare providers, and leading quality improvement initiatives to optimize patient outcomes and satisfaction.

Key Responsibilities:
  • Conduct clinical assessments, including medication reconciliations, post-discharge transitions of care, and emergency department assessments.
  • Collaborate with healthcare providers to ensure compliance with regulatory requirements and industry benchmarks.
  • Lead quality improvement initiatives to address non-adherence and clinical diagnosis for HEDIS/QARR exclusion.
  • Participate in improvement teams and projects to enhance performance, measurement, and documentation.
  • Perform audits on medical records and provide guidance to healthcare providers on documentation standards.
Requirements:
  • License and current registration to practice as a Registered Professional Nurse in New York State.
  • Minimum of three years quality improvement experience in a health plan or healthcare setting.
  • Excellent oral, written, and interpersonal communication skills, including group facilitation.
About VNS Health:

VNS Health is a nonprofit home and community-based healthcare organization dedicated to delivering compassionate care and unparalleled expertise to our neighbors. With a commitment to health and well-being, we strive to simplify the healthcare experience and meet the diverse needs of those we serve.

Benefits:
  • Guaranteed hours
  • 401k retirement plan
  • Employee assistance programs
  • Dental benefits
  • Vision benefits
  • License and certification reimbursement
  • Life insurance
  • Discount program
  • Holiday pay
  • Continuing education
  • Wellness and fitness programs
  • Mileage reimbursement
  • Medical benefits