Utilization Review RN
Our client is currently seeking a Utilization Review Nurse to join their growing team!
This job will have the following responsibilities:
- Conduct pre and post-payment review of inpatient admissions, outpatient services, and other procedures to assess the appropriateness and continuity of care.
- Apply all aspects of the medical review function, including pre-authorization, concurrent review, screening for quality of care issues, and discharge planning. Document rationale for medical decisions made.
- Identify at-risk members who would benefit from health management programs through comprehensive health assessments.
- Monitor and evaluate patient’s plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions.
- Promote member and provider satisfaction.
- Provide continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan.
- Represent Plan in a responsible and professional manner.
- Participate in department initiatives and projects.
- Perform other duties as assigned.
Qualifications & Requirements:
- Valid, Unrestricted RN License
- 3-5 Years Utilization experience
- Previous clinical LTACH, Rehab or Step-Down Unit experience preferred