Utilization Review Registered Nurse, PRN
About The Position
The Utilization Review (UR) Coordinator collaborates with a multidisciplinary team, including physicians, nurses, patient access staff, billing personnel, and external payers, to ensure patients receive the appropriate level of care throughout the continuum of care in an efficient, cost-effective, and quality-focused manner. The UR Coordinator conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and appropriate resource utilization throughout hospitalization. This role serves as a liaison between the hospital and external payers regarding medical necessity, severity of illness, intensity of service, authorization requirements, and timely utilization of hospital services.
Requirements
- Registered Nurse (RN) license
- Experience in utilization review
- Knowledge of medical necessity criteria
- Familiarity with external payer requirements
Nice To Haves
- Experience collaborating with multidisciplinary teams
- Experience with patient status determinations
- Experience with resource utilization
Responsibilities
- Collaborates with a multidisciplinary team, including physicians, nurses, patient access staff, billing personnel, and external payers.
- Ensures patients receive the appropriate level of care throughout the continuum of care in an efficient, cost-effective, and quality-focused manner.
- Conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and appropriate resource utilization throughout hospitalization.
- Serves as a liaison between the hospital and external payers regarding medical necessity, severity of illness, intensity of service, authorization requirements, and timely utilization of hospital services.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
