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Utilization Review Nurse

Accede Solutions Inc (accedesol.com) • Contract • Remote (California, United States, US) • 2d ago

Job Details:

Job Title: Registered Nurse/Utilization Review Nurse - Utilization Review-Remote

Location: 18300 US Highway 18 Apple Valley, CA 92307

Facility: Providence Saint Mary Medical Center - Apple Valley

Duration: 13 Weeks of contract

Weekend Requirements - 4 weekend shifts (days) in a six-week period but can be more

To apply, please submit the following documents:

RN License (CA)

Updated Resume

BLS, ACLS/ Case Management certification

Two Professional References of Current or last organization (Manager's Or Supervisor's )

The Registered Nurse specializing in Utilization Review plays a crucial role in assessing the appropriateness of patient care services and ensuring compliance with clinical guidelines and regulations. This position involves reviewing medical records, coordinating with healthcare providers, and making recommendations to optimize patient care while managing healthcare costs.

Key Responsibilities:

Conduct thorough reviews of patient records to evaluate the necessity and efficiency of healthcare services.

Collaborate with interdisciplinary teams to ensure that patient care aligns with established guidelines and best practices.

Communicate effectively with healthcare providers, insurance companies, and patients regarding care decisions and coverage options.

Identify opportunities for improvement in patient care processes and outcomes.

Maintain accurate documentation of reviews and decisions in compliance with regulatory requirements.

Skills:

Proficient in medical record review and analysis.

Knowledge of healthcare regulations and policies.

Ability to work collaboratively in a fast-paced environment.