Utilization Review RN (Utilization Review)

Asante • MEDFORD, OR

2d

About The Position

The Utilization Review Nurse monitors utilization practices from preadmission through discharge to support cost-effective, quality patient care and ensure patients, physicians, and the hospital/system receive maximum benefits from the health plan. The role also ensures compliance with regulatory requirements throughout the continuum of care.

The nurse receives and shares information related to system, departmental, and patient processes; participates in data collection supporting departmental programs and services; monitors and reports patient outcomes; and works with the interdisciplinary team to improve the delivery of cost-effective services. The position conducts utilization review, evaluates clinical information, communicates findings to payors in accordance with contractual and government regulations, and reviews all admissions for appropriate inpatient versus outpatient or observation status.

This is a full-time, day-shift position with a set schedule that includes every Saturday and Sunday.

Requirements

• Two recent years of progressive nursing experience in an acute care setting, preferably in discharge, utilization, and/or case management, or an equivalent combination of education and experience.
• Registered Nurse license issued by the Oregon State Board of Nursing, required upon start.

Nice To Haves

• Bachelor's degree in nursing.
• Certified Case Manager (CCM).
• Accredited Case Manager (ACM).

Responsibilities

• Receive and disseminate information related to system, departmental, and patient processes.
• Participate in data collection activities supporting departmental programs and services.
• Monitor and report patient outcomes and work with the interdisciplinary team to improve delivery of cost-effective services.
• Conduct utilization review, evaluate clinical information, and communicate findings to payors within contractual and government regulations.
• Review all admissions for appropriate inpatient versus outpatient or observation status.
• Monitor utilization practices from preadmission to discharge and ensure compliance with applicable regulatory requirements.

Benefits

• Medical, dental, and vision coverage for part-time and above employees and eligible dependents, beginning within 30 days of hire.
• Employer-sponsored retirement plan with company contribution and match.
• Generous ETO for part-time and above employees.
• Tuition reimbursement and tuition repayment programs.
• Life insurance.
• Disability coverage.
• Employee assistance programs.
• Weekend shift differential of $2.20 per hour.

What This Job Offers

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