Utilization Review RN/Discharge Planning / Full Time / Days

Elevate your career at Wood County Hospital, where you're not just a number – you're a vital part of a team making a real difference. Utilization Review RN/Discharge Planning / Full Time / Days The Utilization Review Nurse ensures the appropriate utilization of hospital services by conducting clinical reviews to support medical necessity, regulatory compliance, efficient care progression, and safe transitions of care across the continuum. The Utilization Review Nurse is an onsite position. Essential Functions Review clinical documentation to determine medical necessity, level of care, and continued stay appropriateness in accordance with established criteria, payer requirements, and regulatory standards. Collaborate with physicians, nursing, case management, social work, and interdisciplinary teams to support timely care progression, discharge planning, and effective transitions of care. Communicate utilization review findings, authorization requirements, and coverage determinations to providers, payers, and internal stakeholders in a clear and timely manner. Document utilization review activities, decisions, and outcomes accurately within the medical record and designated utilization management systems to ensure compliance and audit readiness. Monitor and support compliance with federal, state, accreditation, and payer regulations by identifying utilization trends, participating in quality improvement initiatives, and assisting with audits and surveys. Prepare, prevent, protect and respond to support our culture of safety. Works hours per week in accordance with offer letter or per attributes of position at transfer request. May be expected to work longer hours as necessary. Other duties as assigned. Requirements Education: Diploma Nurse or ADN from an accredited School of Nursing. License: Registered Nurse in the State of Ohio. Experience: Two years of acute care. Certification: Basic Life Support (BLS). Preferred Education: None. License: None. Experience: None. Certification: None. Physical Requirements Stand or walk for up to 12 hours in an 8-12 hour workday. Sit for up to 12 hours in an 8-12 hour workday. Lift up to 10 pounds during the workday. Perform repetitive hand movements: simple grasping, pushing/pulling, and fine manipulation. Use feet for repetitive movements in operating foot controls. Be able to bend, squat, kneel, and climb occasionally. #J-18808-Ljbffr Wood County Hospital