Utilization Review RN — Drive Care Optimization

capitalhealth; United States; On-site; USD 54,000 - 70,000; Full time

Job summary

Capital Health is seeking an experienced RN for Utilization Management to promote quality, clinical and cost-effective outcomes. You will review treatment plans, communicate with payers, and collaborate with care teams to optimize length of stay and resource use.

Requirements include an Associate's degree in nursing, RN licensure, 5 years clinical nursing and 3 years in quality management or discharge planning, plus UR software and EMR familiarity; knowledge of CMS/MCG guidelines preferred.

Qualifications

• Associate's degree in nursing required; RN license.
• Five years of clinical nursing experience and three years in quality management, utilization review or discharge planning.
• Basic computer skills including MS Office, EMR, UR software.

Responsibilities

• Perform chart reviews to ensure quality, timeliness and appropriateness of care.
• Conduct admission reviews for beneficiaries and private payers based on guidelines.
• Gather clinical information for daily utilization review activities with payers.

Skills

Clinical nursing experience

Quality management

Utilization review

MS Office / EMR familiarity

Education

Associate's degree in nursing

CPHQ, CCM or CPUR preferred

Tools

MS Office

UR software

EMR

MCG guidelines

Job description

Capital Health is seeking an experienced RN for Utilization Management to promote quality, clinical and cost-effective outcomes. You will review treatment plans, communicate with payers, and collaborate with care teams to optimize length of stay and resource use.

Requirements include an Associate's degree in nursing, RN licensure, 5 years clinical nursing and 3 years in quality management or discharge planning, plus UR software and EMR familiarity; knowledge of CMS/MCG guidelines preferred.