What are the responsibilities and job description for the Utilization Review Nurse / Utilization Review / Full Time position at Catawba Valley Medical Center?
Summary of Performance Expectations
Manages the utilization review process for assigned patients. Assesses the appropriateness of admission and treatment plans based upon clinical norms and judgment. Participates in a unified program of concurrent and retrospective monitoring of factors contributing to efficient utilization of hospital resources to provide quality patient care in the most cost effective manner possible. Balances fiscal benefits for the patient with fiscal restraints for the organization that may be imposed by regulatory agencies. Advocates for patients and intercedes as necessary to accomplish these goals. Provides education to the patient, patient’s family/significant others, physicians, administration, and hospital staff related to the utilization review.
Education and Credentials:
Required:
- Graduate of accredited nursing program.
- Current NC RN license or licensure from Nursing Compact State.
- BCLS certification. If the BCLS certification is not from the American Heart Association (AHA), an AHA certification is required within three months of employment date.
- Effective May 4, 2015 newly employed Registered Nurses and current employees promoted to Registered Nurse positions are required to possess a BSN or higher nursing degree.
- The BSN or higher nursing degree must be completed within five years from the date of employment or placement into the RN position.
- Incumbents in CVMC RN positions on the effective date will not be required to satisfy the BSN degree requirement to maintain their current position, be promoted to a charge nurse or Operating Room specialty RN position, or apply for lateral RN positions in another CVMC department. Exception: RNs transferring to the IRT department are subject to the BSN requirement.
- RNs employed in positions at Catawba Valley Medical Group (CVMG), Fairgrove Primary Health and Catawba Valley Infectious Disease are exempt from this requirement.
Preferred:
Work Experience:
Required:
Three years of previous nursing experience. Given training and on-the-job experience, incumbent should be proficient in the basic aspects of the job within three months of employment date.
Preferred:
Two years discharge planning, utilization review, or case management experience.
