Perform initial admission and continued stay reviews utilizing InterQual and MCG to identify and support the appropriate level of care
Abstract data from a variety of medical records to ensure accurate clinical data
Adhere to established quality, timeliness, and productivity outputs required in the completion of first level nursing utilization review
Ensure effective communication internally and externally while delivering excellent customer service
Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training and other opportunities that promote growth
Responsible or ensuring that care being provided in compliance with regulatory requirements and guidelines.
Participate in organizational educational offerings and required training as needed to support service delivery
Help ensure that healthcare resources are used efficiently and effectively, and that patients receive the appropriate care for their needs
Required Qualifications:
Bachelor of Science in Nursing
Must have a current Registered Nurse license
At least 2 years of recent hospital-based Utilization or Case Management Experience
At least 2 years of clinical nursing experience (practice)
Knowledge of current Medicare rules and regulations related to Utilization Review
Strong analytical, organizational and time management skills
Ability to work independently with limited supervision
Excellent written and verbal communication skills
Excellent clinical abstraction and attention to detail
Experience with InterQual and/or MCG is required
Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays Coverage Hours: 7:00AM-1:00AM EST
