Registered Nurse - Utilization Review

Owensboro Health • Owensboro, KY

1d • 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 role involves assessing patient charts, understanding medical conditions, financial status, emotional needs, and support systems. The nurse conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frames. They provide clinical information to payers, collaborate with physicians and the Case Management leadership on complex cases, and deliver regulatory letters to patients as needed. Additionally, the role supports the interdisciplinary team in ensuring quality care and resource information, may assist patients/families with referrals to community agencies and post-acute providers, and provides education as a resource for physicians, staff, and patients/families regarding case management processes. The position may also involve training new case managers, students, and interns.

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.

Nice To Haves

• Works under minimal supervision.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level