Registered Nurse - Utilization Review

Owensboro Health•Owensboro, KY

3d•Onsite

About The Position

Facilitates cost-effective, quality patient outcomes and transitions by determining the appropriate level of care and providing guidance, education, and support to assigned patients. This is a full-time, 0.9 FTE position (72 hours per pay period) in the Case Management department at Owensboro Health Regional Hospital, working 7 p.m. to 7 a.m. No weekend work is required. The role reviews clinical documentation for medical necessity and appropriate level of care, provides clinical information to payers, and collaborates with physicians and the Case Management team regarding hospitalization requirements and delays in services or discharge. The nurse also supports patients and families with education, referrals, and resources, and provides guidance about case management processes to physicians and staff. The position requires a bachelor’s degree or higher in Nursing and a Registered Nurse license eligible for practice in Kentucky upon hire. No prior work experience is required. The employee supports Owensboro Health’s mission, vision, core commitments, and business interests and follows organizational policies and procedures, including those promoting compliance, safety, and high reliability.

Requirements

Bachelor’s degree or higher in Nursing required upon hire.
Registered Nurse licensure and eligibility to practice nursing in the State of Kentucky required upon hire.
No experience required.
Requires critical thinking skills and decisive judgment.
Works under minimal supervision.
Must be able to work in a stressful environment and take appropriate action.

Responsibilities

Assess the complete chart and understand the patient’s medical condition, financial status, emotional needs, and support systems.
Conduct initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frames.
Provide appropriate clinical information to payers within specified time frames.
Collaborate with the Attending Physician, Physician Advisor, and Case Management leadership on patients who are not meeting regulatory requirements for hospitalization and on delays in services or discharge.
Deliver regulatory letters to patients as needed.
Collaborate with the interdisciplinary team to support quality care and provide resource information.
Assist patients and families with referrals to community agencies and post-acute providers and/or provide education and resources, as needed.
Educate and serve as a resource for physicians, staff, and patients or families regarding case management processes.
Train new case managers, students, and interns as needed.
Support Owensboro Health’s mission, vision, core commitments, and business interests; follow organizational policies and procedures and act consistently with a culture of compliance, safety, and high reliability.