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 an acute care setting
  • 5 years clinical nursing experience
  • Demonstrated verbal and written skills
  • Computer skills

Responsibilities

  • Determine appropriateness of hospital admission
  • Assess utilization of resources and medical necessity for continued stay
  • Collaborate with Clinical Care Coordinator and Complex Care Manager for timely discharge
  • Ensure medical documentation reflects patient's severity of illness
  • Maintain compliance with conditions of participation for utilization review
  • Facilitate discharge planning in accordance with payer regulations

Benefits

  • Comprehensive health insurance
  • Retirement savings plan
  • Paid time off and holidays
  • Professional development opportunities
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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