Utilization Review Nurse

Found in: Lensa US P 2 C2 - 2 weeks ago


Decatur, United States Memorial Health University Medical Center Full time

Overview:

This position reviews services to patients of all ages to ensure appropriate status of admission, length of stay and utilization of criteria based Severity of Illness/Intensity of Service. Utilizes clinical and nursing knowledge of documentation requirements to improve overall quality and completeness of clinical documentation of patient records.

Qualifications:

Nurse with current Illinois RN or LPN license. Five years experience in clinical nursing or discharge planning is required.

Responsibilities:
  • Performs admission, concurrent, and focused reviews using InterQual criteria and CMS regulations.
  • Maintains appropriate documentation of reviews.
  • Refers medical records to physician advisors for secondary reviews.
  • Follows up with admitting providers to discuss status orders as necessary.
  • Performs telephone reviews as requested to obtain pre-certification and continued stay certification with private carriers and/or review firms.
  • Participates in unit patient care rounds when possible.
  • Serves as a resource person to physicians and hospital staff in the appropriate use of health care resources.
  • Accepts on-call as scheduled and responds as needed.
  • Takes responsibility for upgrading professional skills and knowledge.
  • Prepares and completes reports; participates in special projects.
  • Performs other duties as assigned.

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