Utilization Review - Registered Nurse

Job Description

Job Summary 

Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition (inpt vs OBS). Facilitates concurrent reviews and authorizations for admissions. This position will support the development of policies and procedures, standard work and educational materials for the UR department. Will be a partner with other staff members, providers, and leadership. Support and focus on performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. 

Essential Functions

• Reviews new admissions using 3rd party product for admission criteria
• Maintains effective working relationships with internal staff, physicians, other providers and staff
• Supports process improvements
• Primarily responsible for the collection and confirmation of accurate documentation in the Medical Record
• Works with healthcare providers to ensure complete and accurate condition and care of the patient
• Serves as a resource to support the UR team in the general development of UR improvement programs
• Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Associate Degree Graduate from an Accredited School of Nursing, ASN required or
• Bachelor's Degree BSN required
• 2-4 years clinical practice experience required
• Experience in HEDIS, MIPS, PQRS, ACO, STARS preferred

Knowledge, Skills and Abilities

• Ability to evaluate a variety of patient situations and make timely decisions – made independently or with appropriate assistance.
• Must demonstrate ability to work in a fast-paced, deadline-oriented environment where the ability to meet deadlines is a must with constant communication required.
• Demonstrates proficient computer skills including accurate data entry in Microsoft Office programs. Strong knowledge of Microsoft Office applications including Word, Excel, and PowerPoint as well as Google suite products required.
• Demonstrates a patient-focused attitude. Committed to providing excellent service to all patients.
• Willingness to assist with genuine interest in the well-being of others.
• Ability to work effectively under pressure to meet deadlines.
• Effective written and verbal communication skills.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Current RN license as issued by the State Board of Nursing required