Utilization Review Nurse
Utilization Review Nurse
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Schedule: 11:00am7:00pm or 9am 7pm. Every 5th weekend
This position reviews services to patients of all ages to ensure appropriate status of admission length of stay and utilization of criteria based Severity of Illness/Intensity of Service. Utilizes clinical and nursing knowledge of documentation requirements to improve overall quality and completeness of clinical documentation of patient records.
Qualifications
Nurse with current Illinois RN. Five years experience in clinical nursing or discharge planning is required.
Responsibilities
- Performs admission concurrent and focused reviews using InterQual criteria and CMS regulations.
- Maintains appropriate documentation of reviews.
- Refers medical records to physician advisors for secondary reviews.
- Follows up with admitting providers to discuss status orders as necessary.
- Performs telephone reviews as requested to obtain precertification and continued stay certification with private carriers and/or review firms.
- Participates in unit patient care rounds when possible.
- Serves as a resource person to physicians and hospital staff in the appropriate use of health care resources.
- Accepts oncall as scheduled and responds as needed.
- Takes responsibility for upgrading professional skills and knowledge.
- Prepares and completes reports; participates in special projects.
- Performs other duties as assigned.
Employment Type
Full-Time
