The Utilization Review Nurse is a vital component in our pre-certification process and works closely with a small team of other medical professionals.  The job duties include, but not limited to, the following:    

 Provide high quality, professional utilization management services by phone

     Prompt, courteous, and error free in response to utilization management functions

     Maintains volume of calls which is comparable to average number of calls handled by unit

     Maintains quality of work by using sound judgment, good analytical and communications skills with attention to detail

     Clear documentation of medical necessity for all admissions and/or extensions

     Accurate completion of CPT and hard copies

     Complete follow through for disposition of cases – MD reviews, chart reviews, audits, case management referrals

     Maintains current information on hospital – TPA accounts (resources)

     Demonstrates accurate understanding of contractual issues for all accounts

     Ability to ascertain if appropriate information for completion of inquiry (i.e. medical necessity)

     Maintains current level of knowledge for nursing, medical and health trend issues

     Exhibits problem solving approaches

     Ability to resolve issues prior to becoming a problem

     Acts as a resource for professional information

     Provide empathy and support to all clients who enter our sphere of influence

     Demonstrates ability to interface with both professionals and nonprofessionals to ensure completion of inquiry in a satisfactory manner

     Ensure maintenance of confidentiality of sensitive information.

     Work with peers and management toward procedure standardization so as to develop consistency and efficiency in providing service to our customers

        Active, unrestricted RN licensure in State of Residence

     Three years acute hospital care and/or UR experience preferred

     Excellent verbal/written communication skills

     Must be self-motivated

     Typing/computer skills a must

     Ability to work standard business hours Monday-Friday (8:30am-5:00pm)

     Ability to travel to Columbus, OH for 2 weeks of training