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Utilization Review Nurse

Lawrence General Hospital

Methuen, MAJobSeen 1mo agoSeen in employer's feed 2 days ago

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At a glance

Compensation
No compensation found
Location
Methuen, MA
Work Authorization
Not specified

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Requirements

Credentials this posting asks for.

Current Massachusetts Nursing LicenseAssociate's degree

Job overview

Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay, working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure accurate documentation, and ensure compliance with participation conditions and payer regulations.

Skills & qualifications

RequiredNice to have

Skills

Verbal CommunicationWritten CommunicationComputer SkillsCase ManagementDischarge PlanningUtilization ReviewClinical Nursing

Qualifications

Graduate of an Accredited Professional Nursing SchoolCurrent Massachusetts Nursing LicenseBachelor’s DegreeMaster’s Degree5 Years Case Management Experience in an Acute Care Setting With Discharge Planning, Continuing Care, Care Management, and Utilization ReviewFive Years Clinical Nursing Experience

Full job description

Position Summary

Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient’s severity of illness; and ensures compliance with the conditions of participation as they relate to utilization review and discharge planning and payer regulations.

MINIMUM EDUCATION AND EXPERIENCE:

Required:

  • Graduate of an accredited professional nursing school

  • Current Massachusetts Nursing license

  • Bachelor’s degree. - Preferred

  • 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.

  • Five years clinical nursing experience

  • Demonstrated verbal, written skills

  • Computer skills

Preferred:

  • Master’s degree.

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