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 job description describes the general nature and level of work required by the position. It is not intended to be an all-inclusive list of qualifications, skills, duties, responsibilities or working conditions of the job. Specific duties and responsibilities consistent with the general nature and level of work described may vary by department and additional related duties may be assigned as needed. Some duties listed may not apply to all employees with this job description. The job description is subject to change with or without notice, and Management reserves the right to add, modify or remove any qualification or duty. Nothing in this job description changes the existing at-will employment relationship between the Organization and the employee occupying the position.

Requirements

Requires critical thinking skills and decisive judgment.
Must be able to work in a stressful environment and take appropriate action.
No experience required.
Bachelor’s degree or higher in Nursing required upon hire
RN - Licensed as a Registered Nurse.
Eligible to practice nursing in the State of Kentucky required upon hire.

Responsibilities

Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
Provides appropriate clinical information to payers as requested within specified time frame.
Collaborates with the Attending Physician, Physician Advisor, Director, Manager, or Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization and delays in services and/or discharge.
Delivers regulatory letters to patients as needed.
Works in collaboration with the interdisciplinary team to ensure quality support of care and resource information
May assist patients/families with referrals to community agencies, post-acute providers, and/or provide education and resources.
Provides education and acts as a resource for physicians, staff, and patients/families regarding case management processes.
Trains new case managers, students, and interns as needed.
Supports Owensboro Health’s Mission, Vision, Core Commitments, and business interests.
Adheres to all organizational policies and procedures.
Executes all tasks and behaves in a manner consistent with a culture of compliance, safety and a high reliability organization.