Responsible for coordinating healthcare and related services for patients.
- Evaluate inpatient and outpatient services within established medical criteria and operational policies and procedures to review appropriate levels of care, lengths of stay and discharge planning and to intervene when necessary to ensure appropriate and effective utilization and quality outcomes.
- Accurately input data for any type of health care service request and perform all inpatient medical and surgical utilization review requests in a timely manner according to department timelines and in conjunction with CMS requirements when applicable.
- Prioritize daily activities through the use of daily utilization reports and processes health care service requests as assigned.
- Communicate and collaborate with providers to ensure effective case management.
Current RN Licensure, BSN highly desired.
Prior Utilization Review experience highly desired.
- EMR/EHR Experience
- Clinical Skills
- Bedside Manner
- Infection Control
- Nursing Skills
- Physiological Knowledge
- Administering Medication
- Medical Teamwork
- Verbal Communication
- Health Promotion and Maintenance