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AbsoluteCare offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many of whom suffer from behavioral health, substance use, and SDoH challenges. We use population health management tools to employ a holistic approach to caring for the highest utilizers of healthcare services in our comprehensive care centers and in the community. AbsoluteCare tends exclusively to the needs of the top four to six percent of the population who persistently represent a disproportionate amount of unnecessary utilization and cost, regardless of whether they are engaged with other PCPs. In our more than 20 years of service, AbsoluteCare has focused on fulfilling the needs of this population. And we have consistently achieved unprecedented outcomes by addressing medical and psychosocial issues, in addition to the hardships of life that can exacerbate chronic health conditions and complicate access to care.
Our Values:
Description:
The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with health plans and different providers/care teams to help ensure inpatient bed days and associated discharge/transitional care plans are appropriate.The Utilization Review Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity and appropriateness of treatment setting by utilizing the applicable policies and guidelines. Utilizes decision making and critical thinking skills in the review and determination of coverage for medically necessary health care services. Is part of a team that accountable for facilitating and providing care coordination services and associated quality outcomes for patients across the continuum of discharge planning and transitional care. Collaborates with different teams to develop and/or implement comprehensive discharge care plans based on assessment of member’s clinical and social needs.
Experience
Our employeesare offered the following benefits
AbsoluteCare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.
Full Time
Ambulatory Healthcare Services
$78k-96k (estimate)
04/22/2023
05/13/2024
The job skills required for Utilization Review Nurse include Health Care, Accountability, Acute Care, Coordination, Critical Thinking, Teamwork, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Nurse positions, which can be used as a reference in future career path planning. As an Utilization Review Nurse, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Nurse. You can explore the career advancement for an Utilization Review Nurse below and select your interested title to get hiring information.