[Hiring] Utilization Review RN @Capital Health (US)
Role Description
Performs a variety of utilization and resource management activities to promote quality, clinical and cost-effective outcomes. Assesses patients' treatment plans, communicates to third party payers, and collaborates with healthcare team members. Performs functions which help to optimize lengths of stay, utilize resources efficiently, and promote cost-effective practices without negatively impacting patient care. Adheres to established standards, practices and procedures.
Qualifications
• Associate's degree in nursing.
• Graduate of an accredited school of nursing.
• CPHQ, CCM or CPUR preferred.
Requirements
• Five years' clinical nursing experience.
• Three years quality management, utilization review or discharge planning experience.
• Registered Nurse - NJ.
• Basic computer skills including working knowledge of Microsoft Office, UR software and EMR.
• Familiarity with MCG guidelines.
• Ability to solve practical problems and deal with a variety of concrete variables.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Benefits
• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• - Healthcare FSA
• - Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• - Less than 10 years of service - $5,000
• - 10+ years of service - $10,000
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• - Voluntary Life Spouse
• - Voluntary Life Employee
• - Voluntary Life Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program
Performs a variety of utilization and resource management activities to promote quality, clinical and cost-effective outcomes. Assesses patients' treatment plans, communicates to third party payers, and collaborates with healthcare team members. Performs functions which help to optimize lengths of stay, utilize resources efficiently, and promote cost-effective practices without negatively impacting patient care. Adheres to established standards, practices and procedures.
Qualifications
• Associate's degree in nursing.
• Graduate of an accredited school of nursing.
• CPHQ, CCM or CPUR preferred.
Requirements
• Five years' clinical nursing experience.
• Three years quality management, utilization review or discharge planning experience.
• Registered Nurse - NJ.
• Basic computer skills including working knowledge of Microsoft Office, UR software and EMR.
• Familiarity with MCG guidelines.
• Ability to solve practical problems and deal with a variety of concrete variables.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Benefits
• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• - Healthcare FSA
• - Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• - Less than 10 years of service - $5,000
• - 10+ years of service - $10,000
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• - Voluntary Life Spouse
• - Voluntary Life Employee
• - Voluntary Life Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program