Utilization Review Nurse
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About The Position
Under the general supervision of the Utilization Management Manager acts as a patient advocate/Case Manager to SSH. Provides Utilization Review (UR) RNs guidance on prioritizing and completing daily tasks to ensure medical necessity criteria is met and to facilitate patients through the continuum of care. Performing the responsibilities below assist with status management, medical necessity reviews, verification of authorization, resource utilization, and denial prevention. The UR Nurse is expected to use best clinical judgment as priorities may shift throughout the day. Works collaboratively with interdisciplinary staff internal and external to the Organization. Participates in quality improvement and evaluation processes related to the management of patient care. The UR Nurse is on-site and available seven (7) days a week as well as holidays and, therefore, is required to work a weekend rotation and also an occasional holiday.
