What are the responsibilities and job description for the Utilization Review Nurse position at Zodiac Solutions Inc.?
Job Summary
The Utilization Review Nurse plays a critical role in evaluating the appropriateness and necessity of healthcare services provided to patients. This position involves working closely with healthcare providers, patients, and insurance companies to ensure that care meets established standards and guidelines. The ideal candidate will possess strong clinical knowledge and excellent communication skills to facilitate effective care coordination.
Duties
- Conduct comprehensive reviews of patient medical records to assess the necessity of services provided, including acute care and hospice care.
- Collaborate with healthcare teams to develop discharge planning strategies that align with patient needs and regulatory requirements.
- Utilize coding knowledge, including ICD-9, to ensure accurate documentation and billing processes.
- Review treatment plans for compliance with Medicare guidelines and other relevant standards.
- Maintain up-to-date knowledge of anatomy and medical terminology to support clinical decision-making.
- Utilize electronic health record systems such as Cerner for documentation and data management.
- Participate in quality improvement initiatives aimed at enhancing patient care outcomes.
- Provide education and support to nursing home staff regarding utilization review processes and standards.
Qualifications
- Registered Nurse (RN) license required; additional certifications in utilization review or case management are preferred.
- Previous experience in a medical office or acute care setting is highly desirable.
- Strong understanding of discharge planning processes and hospice care principles.
- Proficiency in utilizing electronic health records systems, particularly Cerner, is a plus.
- Knowledge of Medicare regulations and coding standards (ICD-9) is essential.
- Excellent analytical skills with the ability to interpret clinical data effectively.
- Strong communication skills, both verbal and written, for effective collaboration with interdisciplinary teams.
- Ability to work independently while managing multiple priorities in a fast-paced environment.
This position offers an opportunity for dedicated nursing professionals to make a significant impact on patient care through effective utilization review practices.
Job Type: Contract
Pay: $55.00 - $60.00 per hour
Work Location: In person
Salary : $55 - $60
