Registered Nurse - Utilization Review

Owensboro Health • Owensboro, KY

33d • 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.

Requirements

• Requires critical thinking skills and decisive judgment.
• Works under minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.
• 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.

What This Job Offers

• Job Type: Part-time
• Career Level: Entry Level
• Number of Employees: 1,001-5,000 employees