Utilization Review Nurse: Optimize Care & Compliance

CommonSpirit Health; United States; À distance; USD 70 000 - 90 000; Plein temps

Résumé du poste

A community hospital in Arizona is seeking a Utilization Management Nurse to ensure healthcare efficiency and quality through diligent review of medical records and adept communication. You'll engage with multiple stakeholders to uphold clinical decision-making and regulatory compliance. The ideal candidate will have strong nursing experience and an understanding of utilization review principles. Join us in providing comprehensive patient care in a supportive environment.

Qualifications

• Graduate of an accredited school of nursing.
• Minimum two years of acute hospital clinical experience or a Master's degree in Case Management in lieu of 1-year experience.
• RN: AZ or Compact License.

Responsabilités

• Conduct admission and continued stay reviews per guidelines.
• Ensure compliance with utilization review principles and hospital policies.
• Communicate and follow up with physicians, payers, and other stakeholders.

Connaissances

Knowledge of federal, state and managed care rules

Excellent written and verbal communication skills

Working knowledge with INTERQUAL or Milliman

Formation

Graduate of an accredited school of nursing

Bachelor's Degree in Nursing (BSN)

Description du poste

A community hospital in Arizona is seeking a Utilization Management Nurse to ensure healthcare efficiency and quality through diligent review of medical records and adept communication. You'll engage with multiple stakeholders to uphold clinical decision-making and regulatory compliance. The ideal candidate will have strong nursing experience and an understanding of utilization review principles. Join us in providing comprehensive patient care in a supportive environment.