RN Utilization Specialist-Utilization Review Casual Days
Core
Registered nurse conducting utilization reviews and audits to ensure appropriate level of care assignment and medical necessity documentation for hospitalized patients.
Role type
Utilization Review Nurse (RN)
Builds
Hospital health care benefit coverage decisions and optimized utilization practices
Domain
Healthcare / Hospital Administration
Required skills
Medical necessity screening, level of care guidelines application, data analysis, conflict management, regulatory compliance knowledge
Preferred skills
Bachelor's Degree in Nursing
Technologies
Data reporting tools, spreadsheets, word processing
Responsibilities
Complete initial admission and continuing stay reviews for hospitalized patients; Collaborate with payors and clinical teams to communicate clinical information; Monitor utilization data elements and report metrics; Resolve utilization dilemmas and escalate complex cases; Participate in interdisciplinary discharge planning rounds; Develop and present utilization education programs for clinicians
Seniority
Mid-level, experienced IC