Utilization Review Nurse

Job Summary: The Utilization Review RN is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care. Essential Responsibilities: Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings. Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures. Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization. Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care. Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission. Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions. Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards. Performs other related duties as directed. Includes Weekend On-Call Rotations Basic Qualifications: Experience Minimum one (1) year of experience as an RN in an acute care setting. Education N/A License, Certification, Registration This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire. Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire OR Compact License: Registered Nurse within 6 months of hire Registered Nurse License (District of Columbia) within 6 months of hire Basic Life Support Additional Requirements: Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability. Ability to effectively communicate. Ability to conform to established policies and procedures. Ability to analytically problem solve and make decisions. Ability to tolerate and cope with ambiguity Ability to work as a team member. Proficiency in the use of applicable computer software. Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well. Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information. Preferred Qualifications: Recent acute care, case management, or home health experience preferred. B.S.N. preferred.aa415a4b-8b21-40fc-a65c-70d2b25ca29a