UTILIZATION REVIEW NURSE

MOUNTAIN VIEW HOSPITAL LLC • Idaho Falls, ID

5d

About The Position

Under the general direction of the UR Supervisor/ Manager, Director of Nursing and the UR Medical Director, the UTILIZATION REVIEW NURSE has the responsibility for assuring prompt, accurate handling of initial medical necessity reviews through the preauthorization and retrospective review process.

Requirements

• Must be a Registered Nurse or Licensed Practical Nurse in the State of Idaho.
• 3+ years of clinical nursing experience practicing clinically.
• Ability to use hospital information system, and operate computer functions and software.
• Ability to write routine reports and correspondence. Ability to speak effectively with physicians, supervisors, nurses, and case managers.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to apply common sense to carry out instructions furnished in written, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
• Ability to work well with others.

Nice To Haves

• Preferred experience with Utilization Management and experience utilizing MCG and Interqual.

Responsibilities

• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria. (Interqual and MCG Criteria)
• Discuss cases with facility healthcare professionals and medical providers to obtain plans of care.
• Participation in discussions with the UR Medical Director, Hospitalists, Nurses and Case Managers to improve the progression of care to the most appropriate level.
• Consult the UR Medical Director, as needed, for complex cases.
• Apply clinical expertise when discussing case with internal and external case managers and physicians.
• Identify delays in care or services and manager with physicians.
• Follow all company procedures in end to end management of cases.
• Obtain clinical information to assess and expedite alternate levels of care.
• Follow up with UR Medical Director for denied cases for peer to peer reviews.
• Maintains a good working relationship both within the department and with other departments.
• Participates in the educational program, completes annual educational requirements, and attends in-service meetings as required.
• Attends all other meetings prepared and ready to participate as required.
• Maintains patient confidentiality at all times.
• Accepts and completes other duties as assigned or requested.
• Must maintain accurate time clock punches, punch in and out according to hospital policy. Follow hospital sick policy for calling in on scheduled day to work.
• Answers incoming calls to the facility in a professional, timely manner.
• Must maintain a professional attitude.
• Must wear appropriate clothing according to dress code.
• Keep a current list of all patients, accounts and insurance carrier.
• Keep all forms current and make changes when needed.
• Keep all equipment and materials working properly and maintained as needed.
• All other duties as assigned.

Benefits

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

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