Utilization Review Nurse

Medix is currently hiring for a Utilization Review Nurse/Care Manager within a Healthcare system in NJ. It is 200 bed facility, which has been up to approx. 65-70 inpt census including ER/ICU. Clinical review submissions vary daily, pending census. Expectation is to complete a minimum of 7-8 clinical using criteria daily. We are looking for RN's that have strong inpatient clinical background or experience in Care Management/Utilization Review. Will be using MCG for review criteria.

Schedule - Monday - Friday (8:30a-4:30p)

Job Description

The Registered Nurse will provide case management/utilization review as well as routine discharge planning services to patients and their families, to facilitate safe and timely discharges, to enhance the benefits of medical care, to ensure hospital reimbursement, to provide cost effective acute care and to ensure continuity of care.

Duties

• Reviews all patient charts within 24 hours of admission to assess appropriateness of admission, intensity of service and potential discharge needs
• Communicates with insurance providers for admission and continued stay reviews as stipulated by contract in order to certify the patients' stays
• Certifies/denies all non-managed care cases on a daily basis, Denied day cases will automatically be referred to the Physician Advisor
• Participants in Interdisciplinary Rounds to review and facilitate the patient's plan of care
• Effectively coordinates care with ancillary departments and attending physician to ensure timely provision of care and to decrease length of stay and appropriate treatment and discharge

Requirements

• Valid Registered Nurse license in New Jersey
• B.S. in Nursing from an accredited school, college or university
• At least two years direct patient care in an acute care hospital
• Knowledge and experience in Medicaid, Medicare, Managed Care Review, communication and documentation requirements
• Knowledge of Utilization Review criteria to include Interqual and/or Milliman