Utilization Review Nurse

Global Force USA; Las Vegas (NV); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Sign on bonus up to $15,000

Job summary

A leading healthcare organization in Las Vegas is seeking a Registered Nurse to review patient admissions for appropriateness and compliance. The ideal candidate will have at least five years of clinical nursing experience, including three years in Utilization Management. Responsibilities include analyzing medical charts and collaborating on discharge planning. A valid Nevada nurse license is required. The position offers a sign-on bonus up to $15,000 and may require weekend shifts.

Qualifications

• Valid license by the State of Nevada to practice as a Registered Nurse.
• Minimum of three years of Utilization Management experience required.
• Recent experience with InterQual and Milliman is necessary.

Responsibilities

• Review patient admissions for appropriateness and compliance.
• Analyze medical charts and determine care efficiency.
• Collaborate with healthcare teams for patient discharge planning.

Skills

Utilization Management experience

Discharge planning

InterQual

Milliman

Collaboration and communication

Education

Graduation from an accredited school of nursing

Five years of acute hospital clinical nursing experience

One year in Utilization Management, Case Management, or Clinical Documentation Improvement

Job description

Sign on bonus may apply up to $15,000

Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.

Job Requirement

Education/Experience: Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.

Licensing/Certification Requirements: Valid license by the State of Nevada to practice as a Registered Nurse.

Additional Position Requirements

• Minimum three (3) years of Utilization Management experience.
• Minimum of three (3) year's experience with discharge planning in an acute care facility.
• Recent documented experience with InterQual, and ability to pass the InterQual exam.
• Recent documented experience with Milliman.

Knowledge, Skills, Abilities, and Physical Requirements

Knowledge of: Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.

Skill in: Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.

Physical Requirements and Working Conditions: Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.