Utilization Review RN

EvergreenHealth•Kirkland, WA

9d•$48 - $76•Onsite

About The Position

EvergreenHealth is seeking an experienced RN to join the Care Management Team. Come join the team, where we consistently earn top honors for patient care and continually look for new and innovative ways to improve. Job Summary: The RN in our Care Management department specializes in assessing hospital admissions for status per defined criteria and reviews for appropriate utilization of resources. Ensures continuity and coordination of care for patients before, during and after hospitalization, and ensures that payer conditions are met. In conjunction with the interdisciplinary team supervises progress and recommends appropriate clinical interventions to nursing staff and attending physicians, ensuring CMS guidelines are met. In conjunction with the interdisciplinary team ensures that patients and families have access to resources for post-hospital care needs. Monitors patients’ medical progress, identifies and addresses patient needs/gaps in service as they move through the system, and obtains authorization for discharge planning as appropriate. Takes action to correct variances in length of stay by following up with physicians and payers as needed. Provides utilization reviews, meeting all time requirements and addresses the discharge appeal process in collaboration with the physician, Dir/Mgr and/or Social Worker Performs other duties as assigned.

Requirements

Current State of Washington RN license
Bachelors of Science degree in Nursing or be actively pursuing a degree in Nursing
Three (3) years of experience as an RN with a combination of acute care and/or case management experience.
Current American Heart Association Healthcare Provider BLS certification by date of hire.
Knowledge of the healthcare financial environment, reimbursement and levels of care.
Knowledge of community resources and how to access them effectively and efficiently.
Interpersonal skills necessary to lead and coordinate an interdisciplinary team and deal effectively with patients and families from a variety of backgrounds and with varied emotional and medical needs.
Age-appropriate developmental assessment skills.
Excellent communication skills to ensure and deliver safe patient care and to provide a legal record of this care.
Accountability for professional nursing practice, commitment to patient care and commitment to uphold the Patient Bill of Rights.

Nice To Haves

Master’s degree in Nursing or other experience and /or educational preparation that would provide the foundation for Nursing Case Management

Responsibilities

Assesses hospital admissions for status per defined criteria
Reviews for appropriate utilization of resources
Ensures continuity and coordination of care for patients before, during and after hospitalization
Ensures that payer conditions are met
Supervises progress and recommends appropriate clinical interventions to nursing staff and attending physicians, ensuring CMS guidelines are met
Ensures that patients and families have access to resources for post-hospital care needs
Monitors patients’ medical progress, identifies and addresses patient needs/gaps in service as they move through the system, and obtains authorization for discharge planning as appropriate
Takes action to correct variances in length of stay by following up with physicians and payers as needed
Provides utilization reviews, meeting all time requirements and addresses the discharge appeal process in collaboration with the physician, Dir/Mgr and/or Social Worker
Performs other duties as assigned.