Utilization Review RN

**THIS ROLE IS FULLY ON SITE 5 DAYS A WEEK**

Responsibilities/ Job Duties:

• Determines the most appropriate level of care and admission status and applies approved criteria and guidelines in decision making, as well as managed care rules and practices in order to ensure a smooth admission experience for patients by coordinating clinical needs with operational processes and insurance benefits
• Collaborates with the attending physician on appropriate hospital status orders
• The clinical admission nurse does not provide direct patient care
• Chart review is used to assess for appropriate level of care and admission status
• Assigns patients to the appropriate units based on clinical assessment while balancing the resources of the organization
• Coordinates with unit charge nurse for bed placement
• Collaborates with nursing operations leader for throughput issues
• Serves as an access point resource for physicians, staff, and patients
• Responds to and assigns all bed request and transfer orders in the electronic medical record
• Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departments
• Evaluates and analyzes quality/utilization cases, admission/discharge criteria, observation/1-day stays, readmits in 30 days, Medicare and diagnosis related criteria
• Consults with physicians in assigning admission level of care status
• Stays up-to-date on Medicare rules and regulations for hospital admission status
• Performs medical record review to assess for appropriateness of admissions and works with the Emergency Room and attending physicians to divert unnecessary admissions
• Monitors and documents avoidable days and recommends change in services or processes
• Responds to requests by the denials management RN for appeal assistance
• Utilizes appropriate downtown procedures for bed placement when applicable
• Assists with data collection and reporting for throughput and bed placement
• Performs chart audits as requested by manager/director

3-5 Must Have Skills/Qualifications

• BSN, RN
• Utilization Review experience
• MCG OR Interqual experience

Schedule/ Shift:

• M-F 10am -6pm or 11am-7pm, no weekends

Salary

• $100,000-115,000

Medix is acting as an Employment Agency in relation to this vacancy.