Utilization Review Nurse

Lawrence General Hospital

$80K — $95K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Graduate of an accredited professional nursing school
  • Current Massachusetts Nursing license
  • Bachelor's degree preferred
  • 5 years case management experience in acute care
  • 5 years clinical nursing experience
  • Strong verbal and written communication skills
  • Proficient in computer skills

Responsibilities

  • Determine appropriateness of hospital admissions
  • Evaluate medical necessity for continued patient stay
  • Collaborate with Clinical Care Coordinator and Complex Care Manager
  • Facilitate timely patient discharge planning
  • Ensure accurate medical documentation of patient severity
  • Maintain compliance with payer regulations and participation conditions
Full Job Description
Position Summary

Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient's severity of illness; and ensures compliance with the conditions of participation as they relate to utilization review and discharge planning and payer regulations.

MINIMUM EDUCATION AND EXPERIENCE:

Required:
  • Graduate of an accredited professional nursing school
  • Current Massachusetts Nursing license
  • Bachelor's degree. - Preferred
  • 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.
  • Five years clinical nursing experience
  • Demonstrated verbal, written skills
  • Computer skills

Preferred:
  • Master's degree.

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