Utilization Review Nurse

• Performs medical record review for severity of illness and intensity of service
• Liaison function with external review agencies to ensure compliance with regulations
• Identifies variance from established pathways
• Collects information from clinical medical record for severity of illness and intensity of service and documents such in clinical database
• Monitors all levels of care for appropriateness and communicates variance
• Evaluates plan of care to ensure it is based on accepted standards
• Provides information to external review organizations
• Refers to designated physician advisor those patients not meeting criteria as well as quality of care concerns
• Maintains knowledge and incorporates current standards into practice

Utilization Review Nurse reviewing medical records for compliance and quality

Utilization Review Nurse performing medical record reviews for severity of illness and service intensity. Acting as a liaison for external review agencies and ensuring compliance with regulations.

• Review medical records to determine the medical necessity of a request for medical services.
• Validate diagnosis and corresponding algorithms of care.
• Evaluate for over-utilization of treatment requests inconsistent with evidence based guidelines.
• Communicate with the claims examiner, providers, and any other auxiliary provider regarding UR determination.
• Summarize medical records and all pertinent information for Physician Advisor.
• Identify the need for medical case management and make recommendations for referral through supervisor.

Utilization review nurse reviewing medical necessity for AvonRisk

Temp LVN/LPN – Utilization Review Nurse

Utilization review nurse position at AvonRisk reviewing medical necessity for services. The role includes validating diagnoses and communicating with various stakeholders.

• maximize the quality and cost-efficiency of health care services at ProMedica
• complete reviews for admissions and transfers
• apply payer rules to obtain authorizations
• work with physicians, nurses, and other members of the health care team
• review cases and look for opportunities to improve hospital service utilization

Utilization Management RN maximizing health care services quality at ProMedica

Utilization Review Nurse – Utilization Management

Utilization Management RN maximizing quality and cost-efficiency of health care services at ProMedica. Collaborating with the healthcare team for reviews, authorizations, and service utilization improvements.

Utilization Review Nurse jobs in United States

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Utilization Review Nurse

Temp LVN/LPN – Utilization Review Nurse

Utilization Review Nurse – Utilization Management