RN - Utilization Review

Providence • Centralia, PA

278d • $49 - $76

About The Position

The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. Utilizes appropriate criteria and interprets the implications of clinical status and the medical treatment plan with current federal regulations/guidelines thereby expediting the billing process, payment and preventing governmental sanction. The UR nurse is responsible for performing comprehensive admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.

Requirements

• Associate's Degree in Nursing.
• Washington Registered Nurse License upon hire.
• 3 years of Nursing experience.

Nice To Haves

• Bachelor's Degree in Nursing.
• 3 years of experience in Utilization Review, Care Management, Quality Management, and/or Discharge planning.

Responsibilities

• Develop and maintain effective processes for determining appropriate admission status.
• Utilize appropriate criteria to interpret clinical status and medical treatment plans.
• Perform comprehensive admission, concurrent, and retrospective UR related reviews.
• Track, evaluate, and report appropriate data.
• Participate in process improvement initiatives with multiple departments.

Benefits

• 401(k) Savings Plan with employer matching.
• Health care benefits (medical, dental, vision).
• Life insurance.
• Disability insurance.
• Paid parental leave.
• Vacation and holiday time off.
• Voluntary benefits.
• Well-being resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Associate degree