Utilization Review Nurse
Lawrence, MAJobSeen todaySeen in employer's feed today
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At a glance
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Requirements
Credentials this posting asks for.
Job overview
The Utilization Review Nurse determines the appropriateness of hospital admission, resource utilization, and medical necessity for continued stay. The role works with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, ensure medical documentation reflects patient severity of illness, and support compliance with utilization review, discharge planning, and payer regulations.
Skills & qualifications
Skills
Qualifications
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:
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Graduate of an accredited professional nursing school
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Current Massachusetts Nursing license
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Bachelor’s degree. - Preferred
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5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.
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Five years clinical nursing experience
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Demonstrated verbal, written skills
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Computer skills
Preferred:
- Master’s degree.
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