Utilization Review Nurse - RN

Singing River Health System • Ocean Springs, MS

56d • Onsite

About The Position

The Utilization Review (UR) Nurse is responsible for ensuring that patient care services meet established medical necessity criteria and align with appropriate levels of care. This role performs concurrent and retrospective reviews to evaluate the appropriateness, quality, and efficiency of care based on the patient’s clinical presentation and services ordered or provided. Using established hospital approved level of care criteria and professional clinical judgment, the UR Nurse determines appropriate patient status and facilitates the use of the most suitable level of care. This role requires maintaining up-to-date knowledge of commercial and government payer requirements, as well as DNV regulations, guidelines, and criteria related to the Utilization Review process. The UR Nurse practices in accordance with professional Standards of Nursing Practice under the leadership and direction of the Utilization Management Director. This position demands the ability to work effectively in high-pressure environments, manage multiple tasks simultaneously with minimal errors, and function independently with strong attention to detail.

Requirements

• Currently licensed to practice as a Nurse in the State of Mississippi.
• Five (5) years’ acute care nursing and/or case management experience.
• De-escalation training completed by the end of position orientation (90 days); must have appropriate level of de-escalation training.
• Keen mental faculties/assessment and decision making abilities.
• Superior communication/speaking/enunciation skills to receive and give information in person and by telephone.
• Strong written and verbal communication skills.
• Emotional stability conducive to dealing with high stress levels.
• Ability to work under pressure and meet deadlines.
• Attention to detail and the ability to multi-task in complex situations.
• Ability to maintain collaborative and respectable working relationships throughout SRHS and other organizations.
• Proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook and Word.
• Ability to be active for extended periods of time without experiencing undue fatigue.
• Ability to work schedules assigned with the understanding that changes may be instituted according to the needs of the hospital for off days, shifts or weekends.

Nice To Haves

• Bachelor’s degree in nursing preferred.
• ACMA (American Case Management Association) or CCM (Certified Case Manager) certification preferred.
• Utilization or Case Management experience preferred.
• Superior customer service skills and professional etiquette.

Responsibilities

• Perform concurrent and retrospective reviews to evaluate the appropriateness, quality, and efficiency of care based on the patient’s clinical presentation and services ordered or provided.
• Determine appropriate patient status and facilitate the use of the most suitable level of care using established hospital approved level of care criteria and professional clinical judgment.
• Maintain up-to-date knowledge of commercial and government payer requirements, as well as DNV regulations, guidelines, and criteria related to the Utilization Review process.
• Practice in accordance with professional Standards of Nursing Practice under the leadership and direction of the Utilization Management Director.
• Work effectively in high-pressure environments.
• Manage multiple tasks simultaneously with minimal errors.
• Function independently with strong attention to detail.
• Demonstrate appropriate clinical judgment and apply appropriate professional skills to a patient population of all ages.

What This Job Offers

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