This Utilization Review Nurse position requires rotating weekend coverage and focuses on assessing the medical necessity and appropriateness of healthcare services. The role involves collaborating with healthcare providers and utilizing clinical expertise to ensure efficient and effective resource allocation.
Location: Apple Valley, California, United States,
Responsibilities:
- Conducting utilization reviews to evaluate the medical necessity of services.
- Analyzing patient medical records and clinical data.
- Collaborating with physicians and other healthcare professionals.
- Applying clinical judgment to make informed decisions regarding healthcare resource utilization.
- Maintaining accurate documentation of review findings and decisions.
- Staying current with healthcare regulations and guidelines related to utilization management.
- Participating in quality improvement initiatives related to utilization review.
Required Skills & Certifications:
- Active Registered Nurse (RN) license in the state of employment.
- Bachelor's degree in Nursing or related field.
- Minimum of two years of experience in hospital, home health, or hospice care.
- Clinical assessment, medication administration, and treatment planning skills.
- Strong communication and interpersonal skills.
- Ability to work effectively in a fast-paced environment.
- Proficiency in electronic medical record systems.
- Knowledge of utilization management principles and practices.
Preferred Skills & Certifications:
- Experience in utilization review or case management.
- Knowledge of various healthcare reimbursement methodologies.
- Certification in utilization review or case management.
Special Considerations:
- Rotating weekend coverage is required.
Scheduling:
- Schedule will include rotating weekend shifts. Specific shift assignments will be determined by the employer.
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