RN Utilization Review Specialist

1. Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with the most efficient utilization of resources. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Performs as an integral part of the interdisciplinary team promoting interdisciplinary collaboration. Facilitates assignment of level of care, consider payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital. Provide superior customer service by modeling the We Care Standards.
    

B.   Essential Job Qualification

      1.   Experience: Minimum 3-5 years relevant clinical medical surgical, ICU or ER experience preferred. Experience in managed care performing utilization review and discharge planning preferred.

      2.   Training/Certification: HC-PRI Certified and PRI screen preferred. CCM certification preferred.

      3.   Licensure: Current NYS RN license required.

      4.   Other: Membership in a professional organization preferred.  Qualities that include effective written and verbal communication skills, decision-making and problem-solving skills, and comprehensive assessment skills.