Utilization Review RN: Elevate Patient Care & Efficiency
Capital Health
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Benefits offered by this job
Job summary
Capital Health is seeking an experienced RN for Utilization Management to optimize patient care, length of stay, and resource use. This role emphasizes collaboration with the medical team, payer interactions, and adherence to CMS guidelines.
Strong clinical nursing background and UR/QA experience are essential, with a focus on quality and cost efficiency. The position requires an associate degree in nursing, RN license, and experience in utilization review or discharge planning.
Qualifications
- Associate degree in nursing required.
- RN license required.
- Five years’ clinical nursing experience plus three years in quality management/utilization review/discharge planning.
Responsibilities
- Perform chart reviews to assess quality, timeliness and appropriateness of care.
- Conduct admission reviews for Medicare/Medicaid and private payers.
- Refer cases to UR physician advisor for review and determination.
- Engage care team to resolve progression of care barriers and optimize resource use.
- Participate in performance improvement activities and daily huddles.
Skills
Education
Tools
Job description
Capital Health is seeking an experienced RN for Utilization Management to optimize patient care, length of stay, and resource use. This role emphasizes collaboration with the medical team, payer interactions, and adherence to CMS guidelines.
Strong clinical nursing background and UR/QA experience are essential, with a focus on quality and cost efficiency. The position requires an associate degree in nursing, RN license, and experience in utilization review or discharge planning.
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