RN Utilization Review II-Hybrid-FT/Days (8a-430p)

Our take on this role

About this role

Review patients' severity of illness and intensity of service against admission and continued-stay criteria. Coordinate authorizations and work with the Physician Advisor on utilization management.

What could you bring from clinical work?

• Nurses: Your experience assessing illness severity and care needs in acute care could help with reviewing patients against admission and continued-stay criteria.

Full job description from Centra Health

Utilization review nurse is responsible for the day to day coordination of admission criteria as it relates to healthcare needs of the patient and organization. Including knowledge of regulatory and compliance with Medicare, Medicaid and other insurance payors. This team member will communicate with a variety of clinical discipline, commercial payers, patient access, patient financial services, physician advisor and other staff members.

Responsibilities

Provides, initial, concurrent and retrospective reviews if assigned patients for severity of illness and intensity of service
Demonstrates the ability to interpret InterQual and Milliman and Roberts criteria to ensure the patients meet admission and continued stay criteria
Provides accurate and complete account authorization and details in plan notes
Performs admission review on the following business day of patient's admission
Involves the Physician Advisor as needed when physician-to-physician interaction is required to achieve appropriate clinical utilization for the patient
Collaboratively works with the Physician Advisor to facilitate all aspects of the utilization management plan
Serve as a liaison to patient accounting, patients access as it relates to authorizations and claims
Demonstrates ability to communicate effectively with internal and external customers
Demonstrates commitment toward customer satisfaction and patient advocacy
Maintains confidentiality of patient/physician/and other team members as well as maintaining compliance with all federal/state guidelines and regulations
Achieves budget length of stay (LOS) goal
May perform other duties as assigned or requested and job specification can be modified or updated at any time

Qualifications

Required Education: Graduate of an accredited Nursing Program.
Required Experience / Skills: Three (3) years of experience in acute care nursing. Computers skills a must as well as excellent communication and the ability to work collaboratively with other disciplines
Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate/compact license. AHA BLS Provider.

Salary Range: $29.29-$45.41/hr.