Utilization Review Nurse - Moscow, ID, United States - Gritman Medical Center

Gritman Medical Center Moscow, ID, United States

2 weeks ago

Healthcare

Description

Job Summary:
At Gritman, we pride ourselves on being the premier healthcare employer on the Palouse. We bring exceptional care that's close to home for the members of our community. We are seeking a Staff RN to join our Utilization Review/Case Management team. The Utilization Review Nurse (UR) has skills in areas of Utilization Management (UM), medical necessity and patient status determination.

This includes examining medical records, treatment and interventions to assist in avoiding payment denials and optimizing reimbursements by assessing the treatment's appropriateness, effectiveness, timing, and setting based on the regulatory and reimbursement requirements of various commercial and government payers.

At times the UR nurse may assist in overseeing the patient discharge plan and play a role in designing after care plans.

Responsibilities:

Evaluating patient care plans and medical necessity
Reviewing patient medical records for compliance with healthcare standards
Coordinating with healthcare providers to ensure appropriate patient care and status
Liaising with insurance companies regarding coverage and approvals
Implementing strategies to optimize healthcare efficiency and cost-effectiveness
Educating healthcare staff about best practices in patient care and cost management
Collaborate with nursing, physicians, admissions, fiscal, legal, compliance, coding, admitting and billing staff.
At times the UR nurse will be required to assist the Case Management department with patients discharge and play a role in designing and implementing after care for discharge

Essential Skills:

In-depth knowledge of healthcare policies and regulations
Strong analytical skills for reviewing medical records and treatment plans
Effective communication skills for collaborating with healthcare providers and insurers
Detail-oriented approach to ensure accurate and comprehensive reviews
Capability to work independently and make informed decisions
Proficiency in healthcare IT systems and electronic health records (EHRs)

Requirements:

Education:
Associates or better in nursing

Experience:

Preferred:
2-3 years acute care experience

Utilization Review experience

Will train the right individual seeking to learn a new unique skill set

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