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Position Summary: The Utilization Review (UR) Nurse is primarily responsible for completing admission review on all patients within 24 hours of admission using electronic InterQual tool. The UR nurse complies all pertinent clinical information to ensure the payor has sufficient information to decide to approve or deny services and Tidelands Health Physician Advisor Team have the necessary information available to assist in getting patient in appropriate status for all referrals. The UR nurse works closely with commercial payors and Tidelands Health internal Physician Advisor Team, business office, registration, and CDI team. The UR Nurse is responsible for tracking clinical service utilization of specific patients from admitting to discharge. Tracking includes the concurrent collection of data, and analysis for appropriateness and timing of interventions. The Case Manager provides practical interpretation of the analysis for nurses, multi-disciplinary teams, medical staff and managers as the findings and recommendations relate to the individual patient’s outcomes, the health plan coverage, and the overall costs for both the patient and the hospital.
Qualifications
Education:
Experience:
Special Skills:
Physical Requirements: Light-Medium Physical Agility Test Rating (PAT)
While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; occasionally (activity or condition exists up to 1/3 of the time) to use hands, fingers; and frequently to talk or hear. The employee must exert 15 to 20 pounds of force occasionally, and/or 5 to 10 pounds of force frequently, and/or greater than negligible up to 5 pounds of force constantly to move objects. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job and will be tested by post offer PAT.
Other
10/05/2022
12/12/2022
tidelandshealth.org
MURRELLS INLET, SC
50 - 100
2002
JOHN HUNGERPIL
$50M - $200M
Ambulatory Healthcare Services
As our regions largest health care provider, Tidelands Health is dedicated to keeping the communities we serve healthy and active, inside and outside of the hospital. Ours is a singular commitment: Better health begins here. Tidelands serves the Carolinas at four hospitals and more than 60 outpatient locations. More than 2,500 employee, physician and volunteer partners are working side by side with our communities to transform the health of our region promoting wellness, preventing illness, encouraging recovery and restoring health.
The following is the career advancement route for RN (Utilization Review Nurse) - Waccamaw Community Hospital (Murrells Inlet, SC) positions, which can be used as a reference in future career path planning. As a RN (Utilization Review Nurse) - Waccamaw Community Hospital (Murrells Inlet, SC), it can be promoted into senior positions as a Head Nurse - CCU that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary RN (Utilization Review Nurse) - Waccamaw Community Hospital (Murrells Inlet, SC). You can explore the career advancement for a RN (Utilization Review Nurse) - Waccamaw Community Hospital (Murrells Inlet, SC) below and select your interested title to get hiring information.
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