RN Utilization Review II: Optimize Patient Care & LOS

Centra Health; Lynchburg (VA); On-site; USD 40,000 - 63,000; Full time

Job summary

Centra Health in Lynchburg, VA is seeking a Utilization Review Nurse to coordinate admission criteria and ensure regulatory compliance for Medicare, Medicaid, and other payors. The role requires collaboration with physicians, payers, patient access, and clinical teams to optimize patient care and admission processes.

The position requires an accredited nursing degree, 3 years of acute care experience, and Virginia RN (or compact) license with BLS.

Qualifications

• Graduate of an accredited Nursing Program.
• Three (3) years of experience in acute care nursing; strong computer skills and excellent communication.
• Current, active RN license in Virginia or a multistate/compact license; AHA BLS Provider.

Responsibilities

• Provides initial, concurrent and retrospective reviews for severity of illness and intensity of service.
• Interprets InterQual and Milliman & Roberts criteria to ensure admission and continued stay criteria are met.
• Performs admission review on the day after patient admission; details in plan notes.
• Collaborates with Physician Advisor to facilitate utilization management.
• Liaises with patient accounting and access for authorizations and claims.
• Maintains patient confidentiality and complies with federal/state regulations.

Skills

Acute care nursing

Computer skills

Excellent communication

Team collaboration

Education

Nursing degree

RN license (Virginia)

AHA BLS Provider

Tools

InterQual criteria

Milliman & Roberts criteria

Job description

Centra Health in Lynchburg, VA is seeking a Utilization Review Nurse to coordinate admission criteria and ensure regulatory compliance for Medicare, Medicaid, and other payors. The role requires collaboration with physicians, payers, patient access, and clinical teams to optimize patient care and admission processes.

The position requires an accredited nursing degree, 3 years of acute care experience, and Virginia RN (or compact) license with BLS.