Utilization Review RN

Prime Healthcare • North Las Vegas, NV

1d • Onsite

About The Position

At North Vista Hospital, the Utilization Review RN is responsible for the quality and resource management of patients admitted to the facility, beginning at admission and continuing across the continuum of health care management. The role advocates for patients, promotes cost containment, and demonstrates leadership in integrating health care providers to support seamless care delivery. The position facilitates quality, clinical, and cost-effective outcomes through holistic, comprehensive admission and concurrent medical-record reviews focused on medical necessity, intensity of service, and severity of illness.

Requirements

• At least five years of work experience after graduating from an accredited school of nursing.
• Current state Registered Nurse license.
• At least one year of experience in case management, discharge planning, or nursing management.
• Basic to intermediate computer skills and knowledge.

Nice To Haves

• Five years of acute care nursing experience.
• CCM certification, or ability to obtain it within one year.
• Knowledge of Milliman Criteria and InterQual Criteria.
• Current BCLS certificate.

Responsibilities

• Manage the quality and resources of patients admitted to the facility from admission throughout the continuum of care.
• Advocate on behalf of patients and promote cost containment.
• Demonstrate leadership in integrating health care providers to facilitate seamless delivery of care.
• Conduct holistic and comprehensive admission and concurrent reviews of medical records for medical necessity, intensity of service, and severity of illness.
• Facilitate quality, clinical, and cost-effective outcomes.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed