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Utilization Review Registered Nurse
2 months ago
Capital Health is seeking a highly skilled Utilization Review Registered Nurse to join our team. As a key member of our clinical staff, you will play a critical role in ensuring the highest quality patient care and optimizing resource utilization.
Key Responsibilities- Conduct thorough chart reviews to identify quality, timeliness, and appropriateness of patient care.
- Perform admission reviews for Medicare, Medicaid, and private insurer patients, utilizing established guidelines to determine the need for inpatient or observation services.
- Collaborate with physicians and other healthcare professionals to ensure accurate level of care determinations and optimize patient outcomes.
- Develop and implement strategies to reduce length of stay and resource consumption, while maintaining high-quality patient care.
- Stay up-to-date on regulatory changes and national coverage determinations to ensure compliance and optimize reimbursement.
- Represent Utilization Management at various committees and professional organizations to promote best practices and quality improvement.
- Minimum of Associate's degree in Nursing from an accredited school.
- Three years of clinical nursing experience or two years of quality management, utilization review, or discharge planning experience.
- Registered Nurse licensure in New Jersey.
- Basic computer skills, including Microsoft Office and EMR systems.
- Knowledge of MCG guidelines and ability to interpret complex data.
This is a full-time position, requiring 8 hours of work per day. The physical demands of this role include frequent sitting, standing, and walking, as well as occasional climbing, carrying, and pushing/pulling.
