Utilization Review Nurse
Where
- Buffalo, NY
What you'll be doing
- Facilitates a process of assessment, planning and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost effective care. Validates appropriate level of care (severity of illness), efficient and effective care delivery (intensity of services) and safe discharge to the next appropriate level of care. Conducts admission and concurrent review using current evidence-based clinical decision support criteria. Completes full assessment of plan of care to determine if criteria are met to ensure third party reimbursement. Enters data into utilization data base. Conducts clinical chart reviews; gathers clinical information to assess and expedite care needs. Discusses cases with treating physician(s) and other healthcare professional to better understand plans-of-care. Identifies and evaluates delays in care. Initiates a discharge planning and readmission prevention plan when applicable. Approves bed days for inpatient cases when applicable. Arranges for alternative care services such as acute long-term care, acute rehabilitation or skilled nursing to move patients through the care continuum. Completes all requirements relative to new alternant level of care orders, admissions and denials. Completes Patient Review Instrument (PRI) prior to admission as needed. Maintains appropriate documentation. Consults with the Medical Director and treating physician(s) as needed to troubleshoot difficult or complex cases. Contacts third party payers with initial and concurrent reviews to obtain authorization for hospital stay. Participates in staff meetings.
What your background should be
- Health Administration, Human Service or a closely related field and two (2) years of behavioral health and/or medical/surgical registered nursing experience. Possession of a license and current registration to practice as a registered professional nurse in the State of New York at time of appointment and possession of a certification as a Patient Review Instrument (PRI) assessor as issued by the New York State Department of Health at the time of permanent appointment.
Required Schooling / Training
- Graduation from a regionally accredited or New York State registered college or university with a bachelor degree in nursing.
Who is the client company
- Healthcare service provider industry.
- If you are interested in this position, send your resume to apply@kochdavis.com
