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RN Utilization Review Specialist
2 months ago
We are seeking a highly skilled RN Utilization Review Specialist to join our team at Confident Staff Solutions. As a key member of our Utilization Management team, you will play a critical role in ensuring the efficient use of healthcare resources.
Key Responsibilities- Conduct concurrent reviews of patients' clinical information to identify opportunities for improvement in care delivery and resource utilization.
- Review precertification requests for medical necessity and ensure that they meet established criteria.
- Monitor the activities of clinical and non-clinical staff to ensure compliance with established policies and procedures.
- Coordinate patients' discharge planning needs with the healthcare team to ensure a smooth transition of care.
- Employ critical thinking and problem-solving skills to:
- Advocate for high-quality care and improved patient outcomes.
- Prevent complications during hospital stays and reduce lengths of stay when possible.
- Maintain accurate and detailed records of all patient-related interactions.
- Prepare monthly reports on patient management and cost savings initiatives.
- Work effectively in a fast-paced environment with minimal supervision.
- Develop and maintain strong relationships with healthcare team members and stakeholders.
- Provide regular updates to the Manager of Utilization Management on key performance indicators and areas for improvement.
- Bachelor's degree in Nursing.
- State licensure as a Registered Nurse (RN).
- Minimum 2 years of prior experience in Utilization Management.
Strong analytical and problem-solving skills.
Remote Work: No
