Utilization Review Professional
2 days ago
As a Utilization Review Professional at Connecticut Children's, you will play a critical part in ensuring that our patients receive high-quality, cost-effective care. In this role, you will work closely with physicians, nurses, and other healthcare professionals to review medical records and determine the appropriateness of admissions and continued stays. This is an excellent opportunity for a skilled nurse to utilize their clinical expertise and analytical skills to drive quality improvement initiatives within our organization.
About You
We are seeking a highly motivated and experienced nurse who is passionate about delivering exceptional patient care. As a Utilization Review Professional, you will need to possess strong communication and interpersonal skills, as well as the ability to analyze complex medical information and make informed decisions. A minimum of 3 years of pediatric clinical experience is required, and previous experience in utilization review or case management is preferred. We offer a competitive salary of $83,000 - $100,000 per year, depending on experience, as well as a comprehensive benefits package and opportunities for professional growth and development.
Key Responsibilities
* Perform admission, concurrent, and retrospective medical reviews to determine the appropriateness of admissions and continued stays
* Function as a liaison between hospital departments, medical staff, and payers on issues related to medical necessity for admission and continued stay
* Maintain open, transparent, and clear lines of communication with physician advisors
* Provide education to clinical staff on utilization review best practices as needed
* Apply standardized criteria and guidelines to assist in determining the appropriateness of admissions and assignment of patient class (i.e., observation, inpatient, and outpatient)
* Identify potential problems regarding payment eligibility for clinical services and recommend corrective action
About Our Organization
Connecticut Children's is the only health system in Connecticut that is 100% dedicated to children. We offer personalized medical care in over 30 pediatric specialties across Connecticut and in two other states. Our team is passionate about providing exceptional patient care, and we are committed to driving quality improvement initiatives throughout our organization. If you are a motivated and experienced nurse who is passionate about delivering high-quality patient care, we encourage you to apply for this exciting opportunity.
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