UTILIZATION REVIEW NURSE

DETAILS

Job Summary :

Provides clinical medical record reviews for appropriateness of inpatient admission vs. observation status. This includes ensuring the patient is placed in the appropriate surgical admission vs. observation status. Conducts daily clinical reviews for all insurance payers, facilitating medical peer to peer review requests.

Education :

Position requires a Bachelor's Degree in Nursing (BSN).

Registration/Certification/Licensure :

RN - State of Maryland, required.

Experience :

Minimum 2 years in clinical nursing, utilization review, and/or case management.

Other Requirements :

Maintains unit-specific and hospital competencies, mandatory learning, and any clinical certifications required in accordance with the Staff Education and Training policy GA-057 and/or any other department requirements.

Effectively communicates with all patient populations and staff by implementing organization-wide communication techniques as a daily practice.

Effectively advocates for quality patient safety and satisfaction as a daily practice.

Demonstrated proficiency of computer skills necessary to effectively complete position requirements—MS Office Products.

Previous experience and demonstrated professionalism in effectively communicating with customers and in promoting a positive service atmosphere.

Ability to work independently in a multi-task environment producing quality work.

Ability to plan, organize, prioritize, and manage multiple functions and complex processes.

Ability to maintain strict patient confidentiality, adhering to HIPAA guidelines.