37 Utilization Review Nurse Jobs near me
Holy Redeemer Health System is Hiring an Utilization Review Nurse Near Jenkintown, PA
To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care as required by the payer. Work with physician advisor to better manage denials and downgrades.
CONNECTING TO MISSION: All individuals, within the scope of their position are responsible to perform their job in light of the Mission & Values of the Health System. Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in our interactions with one another and in the services we provide.
RECRUITMENT and LICENSURE REQUIREMENTS:
Registered Nurse: must have a current license in Pennsylvania from the Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs. Bachelor degree preferred.
Experience:
Registered Nurse: a minimum of five or more years of acute care clinical nursing. Recent experience in a hospital, insurance company, or independent review company in utilization, quality review, homecare or case management
Skills:
- Thorough understanding of managed care systems and utilization review criteria
- Working knowledge of managed care and third party reimbursement
- Experience with case management, evaluation/assessment of clients
- One hour of annual stroke education
- Basic computer skills required
Advocacy and problem solving skills - Excellent time management and strong written and verbal communication skills
Possesses strong organizational and negotiation skills - Possesses strong team work skills
- Strong organizational and prioritizing skills
- Knowledge of community resources
- Demonstrated leadership abilities
EOE
Job Summary
Full Time
$89k-110k (estimate)
05/03/2024
05/16/2024
holyredeemer.com
PHILADELPHIA, PA
3,000 - 7,500
1924
JERALD COHEN
$500M - $1B
Hospital
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About Holy Redeemer Health System
With an emphasis on providing a continuum of care, Redeemer Health remains true to the mission to care, comfort and heal that its Founders, the Sisters of the Redeemer, began in our region in 1924 to provide high quality, compassionate care. Today, Redeemer Health offers a wide range of healthcare and health-related services, including an acute care hospital, home health and hospice services, three skilled nursing facilities, personal care, a retirement community, low-income housing, an independent living community, and a transitional housing program for homeless women and children. With corp ...
orate offices in Huntingdon Valley, PA, Redeemer Health is a Catholic healthcare provider, serving southeastern Pennsylvania and 12 counties in New Jersey, from Union County south to Cape May County.
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The following is the career advancement route for Utilization Review Nurse positions, which can be used as a reference in future career path planning. As an Utilization Review Nurse, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Nurse. You can explore the career advancement for an Utilization Review Nurse below and select your interested title to get hiring information.
