Utilization Review Nurse

Southeast. Always the right career direction.


Job Description Summary
The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute care setting. The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal responsibility, and patient satisfaction.
Job Description

Essential Functions

+ Performs admissions and continued stay reviews of all inpatients and outpatient/observation patients in a bed; at times, this may be retrospective.

+ Performs precertification on procedures ordered while patients are hospitalized.

+ Issues required Medicare/Medicaid notifications of medical necessity changes to patients while hospitalized.

+ Issues notifications of non-coverage letters to ...