Utilization Review RN
UPMCOur take on this role
About this role
Review service use and manage resources for hospital admissions, supporting appropriate length of stay and reimbursement. Assess clinical needs, plan discharges, and manage clinical documentation.
What could you bring from clinical work?
- Nurses: Your experience reviewing patient charts to assess clinical needs and progress could help with assessing medical necessity through chart review.
Full job description from UPMC
Purpose:
Performs the four key functions of case management: Utilization review, Resource management, Managing thecontinuum of care, and Clinical documentation management. Responsible for facilitating appropriate length of stay andreimbursement for all hospital admissions. Promotes quality care through collaboration with all team members.
Responsibilities:
- Utilization ReviewManages consumption of resources ensuring services are patient focused, high quality, efficient and costeffective.Managing the Continuum of Care through assessment of clinical needs and discharge planning.Performs other related duties as assigned
3 years clinical nursing experience in an acute care setting preferred. Ability to assess medical necessity and progress by chart review. Preferred: Certification in Case Management. Computer literacy including operation and software application.Experience in utilization review, discharge planning, case management, or quality improvement.Registered Nurse; Licensure: Ohio Nursing License
Licensure, Certifications, and Clearances:
- Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
- Registered Nurse (RN)
*Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
UPMC is an Equal Opportunity Employer/Disability/Veteran