Utilization Review RN

Shifts Available: Days

Employment Type: Full-time (Monday through Friday)

Hours: 8-hour Shifts

Location: St. Mary's Medical Center

We are seeking a dedicated Utilization Review Registered Nurse to join our team. This registered Nurse role involves assessing patient care plans, ensuring medical necessity and appropriateness, and coordinating with healthcare providers to optimize patient outcomes. The RN will have excellent analytical skills, a strong grasp of healthcare regulations, and a compassionate approach to patient care.

Here are some of the benefits of working at Prime Healthcare:

Health, dental, and vision insurance options
• Paid vacation, sick time and holidays
• Bereavement leave, FMLA and other leave options
• Employer 401K options
• Tuition reimbursement options
• Life, disability, and other insurance options
• Many other amazing benefits

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/

Essential Duties and Responsibilities (includes, but not limited to):

• Conduct comprehensive reviews of patient records to ensure appropriate care levels and resource utilization.
• Collaborate with healthcare providers to develop and implement patient care plans that meet regulatory standards.
• Provide recommendations for alternative care options or adjustments to current treatments as needed.
• Maintain up-to-date knowledge on healthcare regulations and best practices.
• Document all reviews and communications accurately in the hospital's records system.
• Work closely with case management and discharge planning teams to ensure smooth patient transitions.
• Educate staff on utilization review processes and guidelines as needed.

Education and Work Experience

• Starting April 1 2015. Minimum 5 years of work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.
• Grandfathered prior to April 1, 2015. Minimum 5 years postgraduate of an accredited school of social work for licensed clinical social workers. However, an RN case manager is preferred.
• Five years of acute care nursing experience preferred. At least one year of experience in case management, discharge planning, or nursing management is preferred.
• Current BCLS (AHA) certificate, preferred.
• Knowledge of Milliman Criteria and InterQual Criteria preferred.
• Experience and knowledge in basic to intermediate computer skills.

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