Utilization Review Nurse (RN) Home Health (Full time, Monday - Friday, 8AM - 4:30PM)
About The Position
The role of the Home Health Utilization Review Nurse (RN) reports to the Home Health Manager. This position specializes in optimizing patient care by assessing the medical necessity, appropriateness, and efficiency of home health services, including skilled nursing and therapies. Collaborating with interdisciplinary teams and physicians, this position ensures compliance with Centers for Medicare and Medicaid Services guidelines and other regulations, facilitates prior authorizations and discharge planning, and promotes cost-effective care while maintaining high-quality patient outcomes for homebound patients. This position reports to the Home Health Unit Manager.
Requirements
- Must be a graduate of an accredited nursing program
- Arkansas RN license, required
- CPR, required
- Valid drivers license and auto liability insurance, required
- Three years of clinical nursing experience in a home care and/or hospice setting, preferred
- Previous experience in a supervisory and/or management role required
Nice To Haves
- Three years of clinical nursing experience in a home care and/or hospice setting, preferred
Responsibilities
- Conduct utilization review of patient medical records, including documentation, orders, and treatment ensure appropriateness for home health services
- Process prior authorizations, reauthorizations, and requests for extended care periods
- Collaborate with physicians, and other members of the care team to coordinate care, identify needs, facilitate communication, and develop discharge plans
- Monitor patient progress, outcomes, and resource utilization to promote cost-effective care while ensuring quality and compliance to regulatory standards
- Provide feedback to clinical staff regarding medical necessity, homebound status, visit frequency and utilization, and discharge planning
- Collaborate with department leaders to identify performance improvement opportunities and develop performance improvement plans including staff education
- Ensure compliance with organizational policies regarding timely service delivery and data reporting
- Participate in the administrative on-call rotation that includes weekends and holidays
- Works with clinicians and department leaders to ensure clinician documentation is submitted, returned, and sent for signature following Center for Medicare Services guidelines
- Perform monthly supply audits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
