Position Summary:
The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO of private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and family who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.
Qualifications:
Minimum of 1-3 years of related acute healthcare experience and completion of an accredited nursing program.
Must have working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage. Ability to maintain collaborative working relationships to ensure a positive and productive work environment. Ability to plan and prioritize work with frequent interruptions. Ability to provide exceptional customer service. Effective verbal and written communication skills. Knowledge and proficiency of hospital information technology applications.
Requires Current California Board of Nursing Registered Nurse License, Current American Heart Association BCLS certificate, ACLS certificate preferred.
CCM in Case Management Preferred.
