Utilization Review Nurse
Oxford, NCJobPosted 6mo agoSeen in employer's feed 4 days ago
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Job overview
Granville Medical Center is hiring an Utilization Review Nurse. The Utilization Review Nurse conducts patient reviews using screening criteria, identifies and documents delays in services or treatment, and collaborates with departments and providers to resolve issues. This role involves communicating with attending physicians regarding documentation for admission or continuation of hospitalization and referring cases that do not meet criteria to the Director when necessary. The nurse also screens cases for discharge planning and performs concurrent and retrospective reviews.
Key focus areas include Conduct patient reviews as specified in review plan using screening criteria, Identify and document actual and potential delays in services or treatment, and Work with departments and other providers to resolve problems.
Successful candidates bring North Carolina License Registered Nurse, Three Years Clinical Nursing Experience, and One Year Utilization and Review Experience. Important skills include Current Nursing Principles, Current Utilization Management Criteria, Excellent Communication Skills, Work With Physicians And Hospital Staff, Maintains Professional Knowledge, and Self Direction.
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Full job description
Position Summary:
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.
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