Utilization Review Nurse
4 weeks ago
Job Summary:
This role is responsible for the review of medical records for appropriate admission status and continued hospitalization.
Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking.
Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies.
Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions.
Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.
Key Responsibilities:
- Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.
- Reviews include admission, concurrent and post discharge for appropriate status determination.
- Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
- Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
- Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
- Collaborates with facility RN Care Coordinators to ensure progression of care.
- Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.
- Communicates the need for proper notifications and education in alignment with status changes.
- Engages with Denials RN/Revenue cycle vendor to discuss opportunities for denials prevention.
- Coordinates Peer to Peer between hospital provider and insurance provider, when appropriate.
- Establishes and documents a working DRG on each assigned patient at the time of initial review as directed.
- Demonstrates behavior that aligns with the Mission and Core Values of the Organization.
- Responsible for completing required education within established timeframes.
- Adheres to all hospital policies, standards of practice and Federal or State regulations pertaining to their practice.
- Participates regularly in performance improvement teams and programs as necessary.
Qualifications:
- Graduate of an accredited school of nursing
- Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
- Preferred: Bachelor's Degree in Nursing (BSN) or related healthcare field.
- At least five (5) years of nursing 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 preferred.
-
Utilization Review Nurse
1 month ago
Bremerton, Washington, United States Virginia Mason Franciscan Health Full timeJob 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.As a Utilization Review Nurse, you will work collaboratively with attending physicians, consultants, and Care Coordination staff to determine the appropriateness of patient...
-
Bremerton, Washington, United States Travel Nurse Source Full timeJob Summary: We are seeking a skilled Telemetry Nurse to join our team at Amare Medical Network. The successful candidate will be responsible for providing high-quality patient care in a telemetry unit, working closely with physicians to develop treatment plans and utilizing advanced medical equipment to monitor patient vital signs.Key Responsibilities:...
-
Bremerton, Washington, United States Travel Nurse Source Full timeAbout the PositionAtlas Medstaff is seeking a qualified RN (PCU/IMC/Stepdown) for a 13 week contract in the Silverdale, Washington area.BenefitsEvery job with Atlas MedStaff offers a rich benefits package that includes:Comprehensive Health, Dental and Vision insurance401k with matching after 6 monthsTelehealth services for ease of use when an office visit...
-
Registered Nurse
4 weeks ago
Bremerton, Washington, United States Kaiser Permanente Full timeJob Summary:The Care Manager will work in 2 settings on a periodic rotating schedule, planning the discharges and follow up care for Kaiser Foundation Health Plan of Washington patients hospitalized at a nearby network facility and carrying a case load of patients in one of the Kaiser Foundation Health Plan of Washington medical centers. Some weekends and...
-
Travel Cath Lab Technologist Position
4 weeks ago
Bremerton, Washington, United States Travel Nurse Across America Full timeJob Title: Cath Lab TechnologistJob Summary:Travel Nurse Across America is seeking a skilled Cath Lab Technologist to join our team for a travel assignment in Silverdale, Washington. As a Cath Lab Technologist, you will be responsible for assisting doctors during advanced diagnostic and interventional cardiac procedures in the Cardiac Catheterization...
-
Travel Radiology Technologist Position
4 weeks ago
Bremerton, Washington, United States Travel Nurse Across America Full timeWe are seeking a skilled Radiology Technologist to join our team at Travel Nurse Across America. As a Radiology Technologist, you will be responsible for using diagnostic imaging equipment to capture accurate images for medical interpretation. Your tasks will include confirming patient identification, reviewing imaging requests, and explaining procedures to...
-
Nurse Practitioner
4 weeks ago
Bremerton, Washington, United States Kitsap Mental Health Services Full timeAbout the Role:We are seeking a skilled Registered Nurse to join our FACT team as a Mental Health Registered Nurse. In this role, you will collaborate closely with our multidisciplinary team to provide a range of treatment, rehabilitation, and support services to our clients.Your expertise will play a vital role in enhancing clients' quality of life and...
-
RN Case Manager Liaison Nurse
4 weeks ago
Bremerton, Washington, United States Kaiser Permanente Full timeJob Summary:Kaiser Permanente is seeking a skilled Registered Nurse to fill a Case Management position in our Emergency Department. As a key member of our care team, you will be responsible for coordinating patient care, ensuring optimal health outcomes, and promoting efficient use of healthcare resources.Key Responsibilities:Develop and implement...
-
Dialysis Nurse
4 weeks ago
Bremerton, Washington, United States ICONMA Full timeJob Summary:As a Dialysis RN with ICONMA, you will be responsible for delivering high-quality patient care through the nursing process of assessment, diagnosing, planning, implementation, and evaluation. Your expertise will be utilized to direct and coordinate all nursing care of patients based on established clinical nursing practice standards.Key...
-
Nursing Career Opportunities
4 weeks ago
Bremerton, Washington, United States Mercy Full timeCardiac Telemetry Residency ProgramAt Mercy Washington, we are committed to providing exceptional care to our patients. Our 35-bed Cardiac Telemetry unit is a high-paced environment where our team of healthcare professionals work together to deliver top-notch care. We are seeking a Graduate Nurse to join our team and participate in our Cardiac Telemetry...
-
Surgical Care Specialist
4 weeks ago
Bremerton, Washington, United States Virginia Mason Franciscan Health Full timeAt Virginia Mason Franciscan Health, we're committed to delivering exceptional patient-centered care across the Pacific Northwest.As a Surgical Technician in our Orthopedics department, you'll play a vital role in ensuring the safe and effective completion of invasive therapeutic and diagnostic procedures.Under the guidance of surgeons, nurses, or other...
-
Nurse Care Specialist
4 weeks ago
Bremerton, Washington, United States Alumus Full timeElevate your career with Alumus, a company that prioritizes patient care and well-being. As a Registered Nurse, you will utilize the nursing process to provide high-quality care to patients in the comfort of their own homes. Our luxurious, resort-like facilities offer chef-cooked meals, coffee bars, and world-class exercise equipment, making it an ideal work...
-
Nurse Care Specialist
4 weeks ago
Bremerton, Washington, United States Alumus Full timeTransform Patient Care with Encore CommunitiesElevate your nursing career with Encore Communities, where we prioritize patient-centered care and holistic well-being. As a Licensed Practical Nurse, you will play a vital role in delivering exceptional care to our residents.Key Responsibilities:Utilize the nursing process to provide high-quality care to...
-
Travel Nurse RN
4 weeks ago
Bremerton, Washington, United States Cross Country Nurses Full timeJob Title: Emergency Department NurseJob Description:Cross Country Nurses is seeking a travel nurse for a 13-week assignment in the Emergency Department. As an emergency room nurse, you will provide critical care to patients with urgent medical needs. You will assess patients, administer medication, and utilize medical equipment to stabilize their condition....
-
Cardiovascular Nurse Specialist
4 weeks ago
Bremerton, Washington, United States Unavailable Full timeJob Summary:This position is responsible for providing professional nursing services to cardiac patients in an ambulatory setting. The incumbent will assess, coordinate, triage, evaluate, and delegate work to members of the patient care team, and provide specialized cardiac-related consultation and education to patients and...
-
Nurse Care Specialist
4 weeks ago
Bremerton, Washington, United States Alumus Full timeOverviewElevate your career with a team that prioritizes patient care and well-being. At Alumus, we strive to provide a nurturing environment that encourages and inspires our patients to reach their full potential. As a Registered Nurse, you will utilize the nursing process to deliver high-quality care to patients in their homes, focusing on their physical,...
-
Nurse Care Specialist
4 weeks ago
Bremerton, Washington, United States Alumus Full timeOverview:Elevate your career with a team that truly cares about delivering exceptional patient experiences. As a Registered Nurse with Encore Communities, you will be part of a company that prioritizes patient advocacy, evidence-based clinical practices, and holistic care. Our goal is to provide nurturing surroundings that encourage and inspire our patients...
-
Nurse Labor Specialist
1 month ago
Bremerton, Washington, United States Unavailable Full timeJob SummaryThis position is responsible for providing high-quality care to women who are admitted to the Family Birth Center. The ideal candidate will have experience in maternal-fetal assessment, pain management, and newborn care.Key ResponsibilitiesConduct maternal-fetal assessments to identify potential risks and develop individualized care plans.Provide...
-
Nurse Care Specialist
4 weeks ago
Bremerton, Washington, United States Alumus Full timeUnlock Your Potential as a Registered NurseElevate your nursing career with Alumus, a company that prioritizes patient advocacy, evidenced-based clinical practices, and holistic care. Our team is dedicated to improving continuity of care and providing nurturing surroundings that inspire and motivate.The Registered Nurse role at Alumus involves utilizing the...
-
Cardiovascular Nurse Specialist
4 weeks ago
Bremerton, Washington, United States Virginia Mason Franciscan Health Full timeJob Summary:This position is responsible for providing high-quality patient care for cardiac patients in an ambulatory setting, adhering to CHI Franciscan Health standards and values. The incumbent will engage in direct patient care, assessing, coordinating, triaging, evaluating, and delegating work to the patient care team. Additionally, they will provide...