Utilization Review RN

Community Health Systems; Birmingham (AL); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a Utilization Review RN to coordinate discharge planning and enhance patient outcomes. The successful candidate will work within interdisciplinary teams, ensuring care coordination and compliance with medical standards. This role requires strong nursing acumen and knowledge of case management principles, offering a chance to impact patient care significantly.

Qualifications

• 2-4 years of clinical nursing experience required.
• Strong understanding of case management principles.
• RN licensure is mandatory.

Responsibilities

• Oversee discharge planning and transitions of care.
• Conduct daily reviews of medical records.
• Develop and implement discharge plans.

Skills

Communication

Organization

Case Management

Assessment

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Tools

Electronic Medical Records (EMR)

Job description

Join to apply for the Utilization Review RN role at Grandview Medical Center - Birmingham, AL

1 day ago Be among the first 25 applicants

Join to apply for the Utilization Review RN role at Grandview Medical Center - Birmingham, AL

Job Summary

The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards.

Job Summary

The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards.

Essential Functions

• Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services.
• Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues.
• Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs.
• Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions.
• Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
• Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
• Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
• Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards.
• Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.
• Performs other duties as assigned.
• Complies with all policies and standards.
  
  

Qualifications

• Associate Degree in Nursing required
• Bachelor's Degree in Nursing preferred
• 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required
• 2-4 years of care management experience preferred
  
  

Knowledge, Skills And Abilities

• Strong understanding of case management principles, discharge planning, and transitions of care.
• Knowledge of federal, state, and Joint Commission standards related to case management.
• Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams.
• Ability to assess complex situations, identify solutions, and implement care plans efficiently.
• Proficiency in electronic medical records (EMR) and documentation systems.
• Strong organizational and time management skills to prioritize tasks in a dynamic environment.
  
  

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• BCLS - Basic Life Support required
  
  

State Specific Requirements

• Alabama: Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.
• New Mexico: Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications preferred.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Grandview Medical Center - Birmingham, AL by 2x

Get notified about new Utilization Review Nurse jobs in Birmingham, AL.

Birmingham, AL $1,595.79-$1,595.79 4 days ago

Homewood, AL $1,758.00-$1,758.00 4 days ago

Birmingham, AL $1,567.00-$1,567.00 1 week ago

Registered Nurse – Intensive Care - ICU - Travel - (ICU RN)

Registered Nurse (RN) - Full Time - $15,000 Hiring Incentive

Birmingham, AL $1,899.20-$1,899.20 1 week ago

RN - Registered Nurse - Neurology and Neurosurgery Unit (M8) - Multiple Shifts

RN - Registered Nurse - Procedure Lead - Endoscopy - TKC - AM (082)

Procedure RN - Registered Nurse - TKC Ambulatory Intermediate Care Clinic - AM (005)

RN - Registered Nurse - Neurology and Neurosurgery Unit (M8) - FLEXI (885)

Birmingham, AL $1,410.01-$1,410.01 1 week ago

Part-Time Registered Nurse (RN) Remote/Hybrid

RN - Registered Nurse - Cardiothoracic Surgery Unit - Multiple Shifts

RN - Registered Nurse - Surgical Services - Days

Alabaster, AL $1,849.89-$1,849.89 5 days ago

Registered Nurse – Medical Surgical - Travel - (MS RN)

Homewood, AL $2,190.92-$2,190.92 1 week ago

Birmingham, AL $1,637.00-$1,637.00 1 week ago

Travel Medical-Surgical Registered Nurse - $1,562 per week

Birmingham, AL $1,561.40-$1,561.40 3 days ago

RN - Registered Nurse - NICU - Multiple Shifts

Dialysis Registered Nurse Night Shift for Hospital Hiring Bonus

Registered Nurse Supervisor - Full Time - $10,000 Hiring Incentive

RN - Registered Nurse - Clinical Care Coordinator - TKC Plastic Surgery - AM (019)

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.