Utilization Review Registered Nurse (RN)

Inova

5h • Remote

About The Position

Inova Healthsystem is seeking a dedicated Experienced Utilization Review Registered Nurse for a PRN (as needed), day shift, remote position. Inova is recognized as a national healthcare leader in safety, quality, and patient experience, and a top employer. The Utilization Review (UR) Registered Nurse (RN) 1 PRN utilizes utilization management techniques to assess the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. This role is responsible for ensuring timely regulatory compliance and facilitating precertification and payer authorization processes, while actively contributing to clinical performance improvement activities.

Requirements

• Education: BSN from an accredited school of nursing. If RN has an associate’s degree (ADN); must complete BSN within 5 years of start date.
• Experience: Requires a minimum of 1-year Registered Nurse clinical bedside nursing experience.
• Certification: Currently licensed as a Registered Nurse in the State of Virginia or hold a privilege to practice in the State of Virginia under the Enhanced Nurse Licensure Compact (eNLC). Basic Life Support (BLS) for Healthcare Provider certification from the American Heart Association required upon start.

Nice To Haves

• Two (2) year of previous RN utilization review inpatient experience as well as advanced computer skills and EPIC experience is strongly preferred.

Responsibilities

• Collects delay and other data for specific performance and/or outcome indicators.
• Assists in the collection and reporting of resource and financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team.
• Uses concurrent variance data to drive practice changes and positively impact outcomes.
• Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning, chronic disease planning).
• Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
• Ensures safe care to patients by adhering to policies, procedures and standards within budgetary specifications including time management, supply management, productivity and accuracy of practice.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Supports department based goals which contribute to the success of the organization.
• Collaborates/communicates with internal and external case managers and UR RNs.
• Understands pre-acute and post-acute resources.
• Work closely with members of patients' healthcare teams to manage and coordinate all areas of patients' care.
• Works holistically to ensure that healthcare plans and discharge plans meet the physical, social and emotional needs of patients.
• Acts as an advocate for patients to resolve barriers to care progression.
• Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities.
• Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows-up to resolve problems with payers as needed.
• Applies approved clinical criteria to monitor appropriateness of admissions, continued stays or post-acute setting appropriateness and documents findings based on department standards.
• Identifies at risk populations by using approved screening tools and following established reporting procedures.
• Monitors LOS and ancillary resource use, depending on inpatient stay or outpatient program criteria, on an ongoing basis and takes actions to achieve continuous improvement efficiencies in both areas.
• Refers cases and issues appropriately to resolve barriers to care progression.
• Communicates routinely with interdisciplinary healthcare team members and other appropriate parties with regard to the status of patients' care plans and progress toward treatment goals, identification of concerns and/or problems, problem solving and assisting with conflict resolution when necessary.
• Works with the multidisciplinary team to address/resolve system problems impeding diagnostic or treatment progress.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Ensures that all elements critical to patients' care plans have been communicated to the patients/families and members of the healthcare team
• May perform other duties as assigned.

Benefits

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees