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Registered Nurse

2 months ago

Santa Rosa, United States TALENT Software Services Full time
Primary Responsibilities/Accountabilities: Conduct utilization review of patient cases to ensure quality of care and appropriateness of services provided Collaborate with physicians and healthcare professionals to develop and implement patient care plans Evaluate healthcare resource utilization and identify opportunities for improvement Review medical records, lab results, and other clinical information to ensure compliance with established standards and guidelines Provide complex clinical information to insurance carriers and healthcare providers to support reimbursement decisions Document patient care plans and utilization review activities in a timely and accurate manner Participate in ongoing quality improvement initiatives Educate patients and families about healthcare services and resources
Qualifications: Active nursing license Bachelor's degree in nursing or related field Minimum of years of clinical nursing experience Strong knowledge of healthcare delivery systems and utilization management practices Excellent communication skills, including the ability to communicate complex medical information to diverse audiences Ability to work independently and as part of a team in a fast-paced environment Proficient computer skills and experience with electronic health records Experience with quality improvement initiatives and accreditation processes preferred