Registered Nurse (RN) - Utilization Review, Per Diem

Dartmouth Health • Lebanon, NH

127d • Remote

About The Position

The Utilization Review Per Diem position is a remote role that involves working with physicians and multidisciplinary team members to develop a comprehensive plan of care for assigned patients. The primary focus is to ensure that patients are progressing towards desired outcomes by monitoring their care through assessments and patient records. The role also includes identifying and resolving barriers that may hinder effective patient care and being actively involved in the discharge planning process. Inpatient psychiatric utilization management experience is preferred.

Requirements

• Graduate from an accredited Nursing Program required.
• Bachelor of Science Degree in Nursing (BSN) with 3 years of experience.
• Licensed Registered Nurse with NH eligibility.

Nice To Haves

• Masters of Science Degree in Nursing (MSN) preferred.
• Strong leadership, communication, and computer skills desired.

Responsibilities

• Work with the Medical Director and appropriate physician(s) to establish and maintain the Dartmouth-Hitchcock (D-H) ambulatory and inpatient procedure list.
• Review reservation forms and the log of emergent and urgent admissions daily.
• Identify areas that require intervention and education around the use of definitions.
• Review 'one day stays' to assess appropriate use of level of care (LOC) determinations.
• Collaborate with individual physicians and office staff to resolve discrepancies with pre-certifications.
• Oversee inpatient denials, including reviewing denial letters and collaborating with the Medical Director and appropriate physicians to determine whether to appeal or accept denials.
• Assist in responding to Health Plan inquiries regarding denials.
• Develop and implement communication strategies to keep clinicians and staff informed of changes and current practices.
• Work closely with others to transition level of care determinations.
• Provide information to departmental leadership reflecting trends and practices that may need organization, intervention, and change.
• Collaborate with Health Plans to understand their definitions and articulate the definitions of D-H, assisting in the development of strategies for resolution of differences.
• Benchmark with other facilities concerning admission and denial experiences and policies.
• Perform other duties as required or assigned.

What This Job Offers

• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree