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Utilization Review Nurse

Medasource

United States

On-site

USD 65,000 - 85,000

Full time

4 days ago

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Job summary

A leading healthcare organization is seeking a Utilization Review Author to join their Physician Advisory Team on an 8-week contract with possible extension. The successful candidate will be responsible for performing admission and continued stay reviews, ensuring all documentation is accurate, and applying evidence-based criteria. Candidates must possess a current RN license and have experience in Utilization Review or Case Management.

Benefits

Medical insurance

Vision insurance

Qualifications

Must have a current Registered Nurse license.
At least 2 years of recent hospital-based Utilization or Case Management Experience.
Strong analytical, organizational, and time management skills.

Responsibilities

Perform initial admission and continued stay reviews utilizing InterQual and MCG.
Abstract data from a variety of medical records.
Ensure effective communication internally and externally.

Skills

Analytical skills

Organizational skills

Time management skills

Communication skills

Detail-oriented

Education

Registered Nurse license

Tools

InterQual

MCG

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Duration: 8 Week Contract, with possibility of extension

Start Date: ASAP

Job Description:

The Utilization Review Author will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Author will determine the appropriate cases for review, utilizing client specific guidelines. Upon identification of a case, the Utilization Review Author will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria. The successful candidate must have hospital-based Utilization Review or Case Management experience.

Responsibilities:

· Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care

· Abstract data from a variety of medical records to ensure accurate clinical data

· Adhere to established quality, timeliness, and productivity outputs required in the completion of first level nursing utilization review

· Ensure effective communication internally and externally while delivering excellent customer service

· Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training and other opportunities that promote growth

· Complete and maintain annual compliance and annual HIPAA training

· Participate in organizational educational offerings and required training as needed to support service delivery

Minimum Qualifications:

· Must have a current Registered Nurse license

· At least 2 years of recent hospital-based Utilization or Case Management Experience

· At least 3 years of clinical nursing experience (practice)

· Knowledge of current Medicare rules and regulations related to Utilization Review

· Strong analytical, organizational and time management skills

· Ability to work independently with limited supervision

· Excellent written and verbal communication skills

· Excellent clinical abstraction and attention to detail

· Experience with InterQual and/or MCG is required

· Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays Coverage Hours: 7:00AM-1:00AM EST

Seniority level

Seniority level
Associate

Employment type

Employment type
Contract

Job function

Job function
Health Care Provider
Industries
Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

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United States $65,000.00-$85,000.00 1 week ago