What are the responsibilities and job description for the RN Registered Nurse (Hybrid)- Utilization Review - 40 Hours Weekly - HAP Health Alliance Plan position at Health Alliance Plan?
RN Registered Nurse - Utilization Review - 40 Hours Weekly - HAP Health Alliance Plan
Full Time Benefit Eligible
Schedule: Monday through Friday, 8:00AM to 4:30PM, Hybrid
General Summary
The Utilization Review (UR) Nurse ensures services meet member's health needs and promotes the provision of high quality care in the most appropriate and cost-effective setting by identifying, assessing, planning, coordinating, monitoring, and evaluating healthcare services, outcomes, and managing the utilization of Health Alliance Plan (HAP) benefits through activities of medical utilization review and discharge planning. This individual promotes collaboration with the patient care team, such as the Outpatient Case Management team, to ensure a high quality of patient care, reduced length of stay, efficient utilization of resources, and appropriate reimbursement of care and services, including discharge planning assistance and aftercare support. Time may be split between project work and performing clinical reviews.
Education/Experience Required
Full Time Benefit Eligible
Schedule: Monday through Friday, 8:00AM to 4:30PM, Hybrid
General Summary
The Utilization Review (UR) Nurse ensures services meet member's health needs and promotes the provision of high quality care in the most appropriate and cost-effective setting by identifying, assessing, planning, coordinating, monitoring, and evaluating healthcare services, outcomes, and managing the utilization of Health Alliance Plan (HAP) benefits through activities of medical utilization review and discharge planning. This individual promotes collaboration with the patient care team, such as the Outpatient Case Management team, to ensure a high quality of patient care, reduced length of stay, efficient utilization of resources, and appropriate reimbursement of care and services, including discharge planning assistance and aftercare support. Time may be split between project work and performing clinical reviews.
Education/Experience Required
- Nursing Diploma or equivalent.
- Bachelor of Science of nursing degree preferred.
- Four (4) years hospital clinical experience medical, surgical, orthopedic, neuro-surgery or pediatric nursing. Demonstrated knowledge of pathophysiology with application of critical thinking skills. HMO or managed care experience preferred.
- Two (2) years Utilization Management and/or Hospital discharge planning in the acute care setting within the past four (4) years preferred.
- Current, valid Michigan license to practice as a Registered Nurse without any conditions, limitations or restrictions.
- Organization: HAP (Health Alliance Plan)
- Department: Admissions & Concurrent Review
- Henry Ford Health Location: HAP (Health Alliance Plan)
- Shift: Day Job
- Union Code: Not Applicable