RN-Utilization Review- 40/hrs, Day Shifts (Temple Hospital)

Temple University Health System • Philadelphia, PA

3d • Onsite

About The Position

Utilizing InterQual and other appropriate criteria, this role is responsible for reviewing all admissions and continued stays of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. The position determines the medical necessity for admission and continued stays for patients within the department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care, as well as assuring the effective and efficient utilization of available health services. This role also identifies the appropriate level of care for inpatients and outpatients requiring overnight care.

Requirements

• Graduate of an accredited school of nursing
• BSN degree
• 1 year experience of recent Utilization Review in acute care or in an insurance company setting.
• 1 year experience in a medical-surgical setting.
• 1 year experience in working with competency utilizing InterQual criteria.
• General Experience in working with utilization review standards
• PA Registered Nurse License
• Multi State Compact RN License

Nice To Haves

• Certified Case Manager

Responsibilities

• Review all admissions and continued stays of patients utilizing InterQual and other appropriate criteria.
• Determine the medical necessity for admission and continued stays for patients.
• Identify the appropriate level of care for inpatients and outpatients requiring overnight care.

What This Job Offers

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