What are the responsibilities and job description for the Utilization Review Nurse position at N2S Healthcare Staffing Solutions LLC?
Job Title: RN - Utilization Review Lead
Location: Anacortes, WA, 98221
Department: Utilization Review
Shift: 8 Hour Variable
Type - Full time Benefits
Salary : $37hour -$45 - $67/hour (As per Experience)
Job Purpose:
We are seeking a dedicated and experienced Utilization Review RN, Lead to oversee and coordinate Utilization Review (UR) services within our Care Management Department. Under the leadership of the ACU/CM Manager, you will ensure compliance with all CMS regulations and provide guidance to other UR RNs and Social Workers.
Key Responsibilities:
- Lead and support Utilization Review activities, providing education and direction to team members.
- Conduct thorough reviews of medical records to assess medical necessity for inpatient and observation status.
- Collaborate with healthcare teams to identify issues in utilization and implement effective resource management strategies.
- Develop and coordinate discharge plans, ensuring patient involvement and addressing potential post-hospitalization challenges.
- Advocate for services and funding aligned with care plan goals, while adhering to state and federal regulations.
- Foster professional relationships across departments to ensure comprehensive patient care and effective communication.
- Participate in multidisciplinary care rounds and assist with budget performance management.
- Maintain compliance with external requirements and contribute to continuous quality improvement initiatives.
Qualifications:
- Current RN license in Washington State.
- Proven experience in Utilization Review or Care Management.
- Strong leadership and communication skills.
- Ability to collaborate effectively with healthcare professionals and patients.
- Knowledge of CMS regulations and payer requirements.
Salary : $37 - $67
