What are the responsibilities and job description for the Utilization Review Nurse position at CommonSpirit Health?
As a Utilization Review nurse with CHI St Vincent Little Rock, you’ll work with physicians, other registered nurses, specialized departments, and community resources. This provides patients with the education and resources needed to build a care plan at discharge.
You’ll build trust in these interactions by showing compassion, using your critical thinking skills, and remembering that each patient requires a custom care plan tailored to their needs. You will support patients by identifying and removing patient care barriers that will regress their healing. Your talent for creative thinking is vital to your success in case management. It shines as you develop enhanced discharge plans yielding optimal outcomes for each patient.
CHI St Vincent Infirmary is a 600 bed faith-based, non-profit, acute care facility providing quality health care to patients and communities from all over the State of Arkansas. Our level II trauma center is a regional referral center for cardiology, trauma, behavioral health, cancer care, neurosciences, and other specialties. We have been consistently named by US News & World Report as one of the State’s best hospitals, with high performance in heart care, colorectal surgery, and joint replacement.
If you are committed to social justice, health equity, and prepared to deliver care in new, innovative ways, you belong with us.
Responsibilities
- Analyzes insurance, governmental and accrediting agency standards to determine criteria concerning admissions, treatment and length of stay of patients.
- Reviews medical records for appropriate level of care.
- Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine appropriateness of treatment and length of stay.
- Abstracts data from records and maintains statistics.
- Monitors and tracts Medicare denials, works with medical records to review third party payor denials.
- Works with other disciplines to develop a discharge plan appropriate for patients Identified needs.
- Works closely with providers regarding patient status and appropriate level of care.
- Rounds on patients, available to answer questions and help with discharge planning needs of patient.
- Records all care information concisely, accurately and completely, in a timely manner, in the appropriate format and on the appropriate forms
- Maintains order, stock, and cleanliness of all areas in the department
- Practices safe work habits, compliance with safety rules and regulations, and adheres to safety policies
- Utilizes resources appropriately and follows facility guidelines, policies, and procedures
Qualifications
- Unencumbered license to practice in the State of Arkansas
- 4 years of acute care nursing experience required
- BSN Required
- Previous case management, utilization management, or discharge planning experience strongly preferred
