What are the responsibilities and job description for the Utilization Review Nurse position at Continuum Health Providers?
Job Summary
We are seeking a dedicated and knowledgeable Utilization Review Nurse to join our Continuum Health Providers Team. The ideal candidate will play a crucial role in evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients (children, adolescents, and adults). This position requires strong clinical judgment and an understanding of medical management processes within behavioral health, partial hospitalization and intensive outpatient program settings. The Utilization Review Nurse will collaborate with our physicians, clinical and nursing staff to ensure optimal patient outcomes while adhering to established guidelines and protocols.
Duties
- Conduct comprehensive reviews of patient medical records to assess the necessity of services rendered.
- Collaborate with physicians, clinical staff, nursing staff, and other healthcare professionals to discuss treatment plans and ensure appropriate care levels.
- Utilize knowledge of behavioral health, partial hospitalization programs, intensive outpatient programs, and medical management to evaluate the appropriateness of care for patients in various settings, including admissions and discharge.
- Analyze health information management data to identify trends and areas for improvement in patient care.
- Ensure compliance with regulatory requirements and managed care guidelines throughout the review process.
- Document findings clearly and concisely in accordance with organizational policies.
- Participate in interdisciplinary meetings to discuss cases requiring further review or intervention.
- Provide support to staff regarding utilization review processes and best practices including participation in treatment team as needed.
Experience
- A valid South Carolina nursing license is required; experience in a hospital on a behavioral health unit or clinical setting is preferred.
- Previous experience in utilization review or case management is highly desirable.
- Familiarity with managed care principles and practices is beneficial.
- Knowledge of behavioral health, partial hospitalization and intensive outpatient prorams and settings, is advantageous.
- Strong analytical skills with the ability to interpret complex medical information effectively.
- Excellent communication skills for collaboration with diverse healthcare teams.
Join our team as a Utilization Review Nurse where you can make a meaningful impact on patient care through your expertise and commitment to quality healthcare.
Job Type: Part-time
Pay: $33.94 - $38.03 per hour
Expected hours: No more than 36 per week
Benefits:
- Flexible schedule
Schedule:
- 10 hour shift
- 8 hour shift
- Day shift
- Monday to Friday
- No weekends
Work Location: In person
Salary : $34 - $38