Utilization Review Nurse - Weekends

University of Arkansas•Little Rock, AR

3d•Onsite

About The Position

The Utilization Review (UR) RN Care Manager is responsible for utilizing pre-established, evidence based screening criteria to validate the appropriateness of patient admissions, provide screening, and continuous observation status monitoring. The RN Care Manager UR is also responsible for communicating relevant information to appropriate payer carriers regarding a patient’s stay. The role reflects appropriate knowledge of the RN scope of practice, current state requirements, CMS Conditions of Participation, Patient Bill of Rights, AB 1203 and other Federal or State regulatory agency requirements specific to discharge planning.

Requirements

Associate’s Degree in Nursing (ADN)
5 years of clinical nursing experience
Valid AR Registered Nursing license.

Nice To Haves

Certified Case Manager (CCM) or American Case Management (ACM) certification

Responsibilities

Initiates appropriate referrals to internal and external interdisciplinary teams.
Establishes a working diagnosis on every patient at the time of the initial review.
Communicates the target length of stay and estimated discharge on every patient at the time of the initial review and coordinates the discharge planning process in collaboration with the interdisciplinary team.
Documents all team, physician, and payer communication and concerns pertaining to coordinating of care and services.
Responsible for utilizing pre-established evidence-based screening criteria to validate the appropriateness of patient admission and provide appropriate screenings of the patients assigned to a designated coverage area, including initial, continued stay and completion of discharge screens.
Communicates with physicians regarding the level of care or admission status when appropriate criteria are not met for inpatient, observation, or continued stay review.
Escalates appropriate cases to Physician Advisor for secondary review process.
Escalates payer denial/appeal issues to the Physician Advisor/CMO/Attending in a timely fashion.
Other duties as assigned to meet UAMS core values and the business needs of the department.