Utilization Review RN - FT - Day - Utilization and Resource Mgmt Pennington NJ
$81,952,000–$107,057,600 year
On-sitePennington, New Jersey, United States
Job Summary
Conduct daily chart reviews and admission reviews for Medicare, Medicaid, and private insurers to assess patient care quality, timeliness, and appropriateness. Perform concurrent and retrospective clinical reviews with payers while adhering to CMS guidelines, and collaborate with physicians to optimize length of stay and resource utilization. Identify preventable delays, recommend care alternatives, and participate in daily huddles and performance improvement activities. Requires an Associate's degree in nursing, five years of clinical experience, and three years in quality management or utilization review.
Required Qualifications
- Associate's degree in nursing
- Graduate of an accredited school of nursing
- Registered Nurse - NJ
- Five years' clinical nursing experience
- Three years quality management, utilization review or discharge planning experience
- Basic computer skills including the working knowledge of Microsoft Office
- Working knowledge of UR software
- Working knowledge of EMR
- Possesses familiarity with MCG guidelines
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
- Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
- Accurate Near Vision
- Accurate Far Vision
- Accurate Color Discrimination
- Accurate Depth Perception
- Accurate Hearing
- Sitting
- Standing
- Walking
- Climbing (e.g., stairs or ladders)
- Carry objects
- Push/Pull
- Twisting
- Bending
- Reaching forward
- Reaching overhead
- Keyboard use/repetitive motion
- Talk or Hear
- Lifting Floor to Waist 15 lbs
- Lifting Waist Level and Above 15 lbs
Desired Qualifications
- CPHQ
- CCM
- CPUR
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