Utilization Review Nurse
Description:
Job Description
Schedule: Monday – Friday, 8:00 AM – 4:30 PM
Job Type: Permanent Role
Position Overview
Are you an experienced RN with a passion for utilization review and case management? Join our dedicated team at OakLeaf Surgical Hospital and make a significant impact on patient care! As a Utilization Review RN, you'll play a crucial role in coordinating medical care and discharge planning, ensuring compliance with healthcare standards, and advocating for patients. This is a fantastic opportunity to advance your career in a supportive and collaborative environment.
Key Responsibilities
Facilitate Coordination of Medical Care: Work closely with interdisciplinary teams, service organizations, agencies, and healthcare facilities to ensure seamless patient care and discharge planning.
Conduct Medical Record Reviews: Use specific indicators and criteria approved by medical staff, The Joint Commission, CMS, and other state and federal agencies to review medical records and ensure compliance.
Ensure Documentation Standards: Verify that physician and nurse documentation meets established standards and guidelines.
Apply Utilization Review/Case Management Rules: Understand and implement utilization review and case management rules and guidelines to ensure compliance and optimal patient care.
Educate Healthcare Team: Provide education to healthcare team members on case management and managed care concepts, enhancing their understanding and application of these principles.
Serve as Patient Advocate: Act as a liaison between patients, families, and the healthcare team, advocating for patient needs and ensuring collaborative relationships.
Reinforce Patient/Family Education: Facilitate and reinforce patient and family education to ensure a smooth and positive discharge transition.
Investigate and Report Adverse Occurrences: Investigate adverse occurrences, report findings, and educate staff on resource utilization, discharge planning, and psychosocial aspects of healthcare delivery.
Assist with Regulatory Reporting: Support the PI Data RN with data gathering and analysis to meet regulatory reporting requirements.
Collaborate with Social Workers: Work collaboratively with Social Workers to address the psychosocial needs of patients and their families or caregivers.
Perform Other Duties: Take on additional responsibilities as assigned to support the overall goals of the hospital and patient care.
Must-Have Experience & Qualifications
2+ years of experience in Utilization Review.
RN License in Wisconsin.
BLS certification upon hire.
Experience following MCG guidelines.
Experience with Case Management and Discharge Planning.
Why Join Us?
Physician-owned: Doctors are highly engaged and hands-on with nurses.
Great work-life balance: 8-5 hospital hours with no on-call duties.
Employee perks: Enjoy free cold and hot bars for all meals throughout the day.
Free scrubs: Provided to all employees.
Comprehensive benefits: Excellent benefit packages available.Company Description
We focus on building genuine relationships and making a meaningful impact. Here's a quick summary of what we do:
Empowerment Through Opportunity: We help people find jobs that match their skills and aspirations, providing opportunities for personal and professional growth.
Comprehensive Services: We offer temporary-to-permanent hiring, cultural consulting, program management, and skill development programs, including one-on-one mentorship and classroom training1.
Values-Driven: Our core values include caring for others, high character, hard work, and leadership that serves. We believe everyone matters and strive to take care of our employees, clients, and candidates1.
Community Impact: We are committed to making a positive impact on our communities and the planet, tackling issues like equity, healthcare access, and climate change.
Working with Insight Global means being part of a company that values people, fosters growth, and strives to make a difference.
Please send updated resume, 2 references for consideration!
Full-time