Utilization Review Nurse (RN)

About the Opportunity A healthcare organization in Ohio is actively seeking a licensed Registered Nurse (RN), with a Utilization Review background, to join their staff as their new Utilization Review Nurse. Collaborating with healthcare providers and members, the Utilization Review Nurse (RN) will be responsible for promoting quality member outcomes, optimizing member benefits, and promoting effective use of resources. Apply today! Company Description Healthcare Organization Job Description The Utilization Review Nurse (RN) will be responsible for:. Conducting pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensuring member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consulting with Clinical Reviewers and/or Medical Directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborating with providers to assess members needs for early identification of and proactive planning for discharge planning. Facilitating member care transition through the healthcare continuum and referring treatment plans/plan of care to Clinical Reviewers, as required. Facilitating accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards Required Skills. 2+ years of experience in a Hospital setting. Associate’s Degree in Nursing. OH Registered Nurse (RN) license. Acute Care background. Solid assessment, clinical, and documentation skills. Patient oriented. Great interpersonal skills. Excellent communication skills (written and verbal). Strong attention to detail. Highly organized Desired Skills. 2+ years of Utilization Management experience. Bachelor’s Degree in Nursing