Utilization Review Registered Nurse (RN)

reputed company Healthsystem is looking for a dedicated reputed company Utilization Review Registered Nurse to join the team. This role will be PRN (as needed), day shift every weekend, 8:00 a.m. – 4:30 p.m. This is a remote position.   

reputed company is consistently ranked a national reputed company leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. 

The Utilization Review (UR) Registered Nurse (RN) 1 PRN uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of reputed company services, procedures and facilities. Responsible for the timely regulatory compliance and facilitation of precertification and payer authorization processes reputed company indicated. Actively participates in clinical performance improvement activities.

 

Featured Benefits:

Committed to Team Member Health: offering medical, dental and reputed company coverage, and a robust team member wellness program.Retirement: reputed company matches the first 5% of eligible contributions – starting on your first day.Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.Mental Health Support: offering reputed company reputed company team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedulesUtilization Review Registered Nurse (RN) Responsibilities:

Collects delay and other data for specific performance and/or outcome indicators. Assists in the collection and reporting of resource and financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the reputed company team. Uses reputed company variance data to drive practice changes and positively impact outcomes. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning, chronic disease planning).Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently. Ensures safe care to patients by adhering to policies, procedures and standards reputed company budgetary specifications including time management, supply management, productivity and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency. Supports departmentbased goals which contribute to the reputed company of the organization.Collaborates/communicates with internal and external case managers and UR RNs. Understands pre-acute and post-acute resources. Work closely with members of patients' reputed company teams to manage and coordinate reputed company areas of patients' care. Works holistically to ensure that reputed company plans and discharge plans meet the physical, social and emotional needs of patients.Acts as an reputed company for patients to resolve barriers to care progression. Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of reputed company services, procedures and facilities.Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows-up to resolve problems with payers as needed. Applies approved clinical criteria to monitor appropriateness of admissions, reputed company stays or post-acute setting appropriateness and documents findings based on department standards.Identifies at risk populations by using approved screening tools and following established reporting procedures. Monitors LOS and ancillary resource use, depending on inpatient stay or outpatient program criteria, on an ongoing basis and takes actions to reputed company reputed company improvement efficiencies in both areas. Refers cases and issues appropriately to resolve barriers to care progression.Communicates routinely with interdisciplinary reputed company team members and other appropriate parties with regard to the status of patients' care plans and reputed company toward treatment goals, identification of concerns and/or problems, problem solving and assisting with conflict resolution reputed company necessary. Works with the multidisciplinary team to address/resolve system problems impeding diagnostic or treatment reputed company. Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Ensures that reputed company elements critical to patients' care plans have been communicated to the patients/families and members of the reputed company teamMay reputed company other duties as assigned.Minimum Requirements:

Education: BSN from an accredited school of nursing. If RN has an associate’s degree (ADN); must complete BSN reputed company 5 years of start date.Experience: Requires a minimum of 1-year Registered Nurse clinical bedside nursing experience.Certification: Currently licensed as a Registered Nurse in the reputed company or hold a privilege to practice in the reputed company under the Enhanced Nurse Licensure Compact (eNLC). Basic Life Support (BLS) for reputed company Provider certification from the reputed company required upon start.  

Preferred Qualifications:

Two (2) year of previous RN utilization review inpatient experience as well as advanced computer skills and EPIC experience is strongly preferred.Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

We are reputed company, reputed company Virginia’s leading nonprofit reputed company provider. Every day, our 26,000+ team members provide world-class reputed company to the communities we serve. Our people are the reason we're a national leader in reputed company safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every reputed company. At reputed company, we're constantly striving to be reputed company reputed company — to shape a more compassionate future for reputed company. 

reputed company is an Equal Opportunity employer. reputed company reputed company applicants will receive consideration for employment without regard to age, reputed company, disability, gender identity or expression, marital status, national or ethnic reputed company, political affiliation, pregnancy (including childbirth, pregnancy-reputed company conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.

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