Utilization Review Nurse

CommonSpirit Health • Seattle, WA

2d • Onsite

About The Position

As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and optimal patient outcomes. You will leverage specialized utilization review criteria, technologies, and tools to verify the correct level of care throughout their acute stay. Every day you will perform meticulous clinical assessments, identify and coordinate cost-effective alternatives, and proactively support provider decision-making. You will collaborate with the healthcare team, patients, families, and both internal/external customers to achieve optimal outcomes efficiently and ethically, ensuring compliance with payer guidelines and regulatory standards. To be successful in this role you will have strong analytical skills, persuasive communication, and a steadfast commitment to patient advocacy. Fiscal stewardship is crucial for navigating complex clinical and financial landscapes, ensuring appropriate resource utilization.

Requirements

• Bachelor's degree in Nursing
• 3 years of professional nursing experience in a hospital setting
• Experience in utilization review
• Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care
• An understanding of variable payor rules and regulations

Nice To Haves

• Knowledge of core insurance coverage guidelines and financial principles
• Acute care nursing experience

Responsibilities

• Ensure the medical necessity and appropriateness of care for all hospitalized patients.
• Promote fiscal responsibility and optimal patient outcomes.
• Leverage specialized utilization review criteria, technologies, and tools to verify the correct level of care throughout their acute stay.
• Perform meticulous clinical assessments.
• Identify and coordinate cost-effective alternatives.
• Proactively support provider decision-making.
• Collaborate with the healthcare team, patients, families, and both internal/external customers to achieve optimal outcomes efficiently and ethically.
• Ensure compliance with payer guidelines and regulatory standards.

What This Job Offers

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