Utilization Review Nurse RN or LPN

Unity Health • Searcy, AR

7d • Onsite

About The Position

This position requires the ability to work under pressure and in conditions of frequent interruptions. The role demands considerable initiative and judgment while performing duties in an area where procedures are standardized but where frequent independent decisions are required. The Utilization Review Nurse will help maintain a quality control system to assure effective utilization of hospital facilities and services. They will assist in the promotion and maintenance of high-quality care through review of clinical practices within the hospital based on pre-established criteria. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, and promoting clinical best practice. The goal is to ensure all patients receive 'the right care, the right cost, right time, and in the right setting.' This position requires knowledge in the care of patients served, including infants to adolescents (0-17 years), adults (18-65 years), and geriatrics (65 years and above). The physical demands include sitting at a desk when not locating records or performing concurrent review on nursing stations. The work environment is a well-lighted, air-conditioned office.

Requirements

• Current Arkansas licensure as a RN.
• Skilled in the use of the computer and photocopier.
• Good people and phone skills required.
• Past experience working with Medical Staff, patients, hospital associates and insurance companies.
• Capable of following verbal and written instructions.
• Practice diplomacy in dealing with Medical Staff, patients, associates and insurance companies.
• Must be able to communicate verbally and in written format with the Medical Staff, review organizations, administration and others as indicated.
• Must be able to apply current nursing knowledge to determine appropriate acuity levels and appropriate care by chart review.
• Knowledge in the care of patients served (Infant to adolescence, Adult, and Geriatric).

Nice To Haves

• Preferably experienced in the use of ICD-CM and CPT coding systems.

Responsibilities

• Maintain a quality control system to assure effective utilization of hospital facilities and services.
• Assist in the promotion and maintenance of high-quality care through review of clinical practices within the hospital based on pre-established criteria.
• Integrate and coordinate utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, and promoting clinical best practice.
• Ensure all patients receive 'the right care, the right cost, right time, and in the right setting.'
• Perform concurrent review on nursing stations.
• Locate records and other various information for nurses, doctors, etc.

What This Job Offers

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