What are the responsibilities and job description for the Utilization Review RN position at University of Maryland Medical System?
Job Requirements
Job Summary
Utilization Review coordinates the care and service of selected patient populations across the continuum. He/ she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most cost-effective use of available resources. Utilization Review assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients’ treatment and transitional needs.
COLLABORATION: Collaborates with the physician and other healthcare professionals to promote appropriate use of medical center resources. Participates as a team member to facilitate communication among all disciplines, identify barriers to meeting treatment goals, and determines ways to achieve best outcomes. Participates in the hospital Ethics Committee, as well as facilitates the hospital UR committee.
DOCUMENTATION AND MEASUREMENT: Uses established criteria to determine appropriateness of admissions, transfer and continued stays. Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/ agencies adhering to legal mandates regarding confidentiality. Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicates (e.g. overall length of stay, readmission rates, feedback from referral services, etc.).
PATIENT CARE: Uses severity of illness/ intensity of services indexes to determine appropriateness of admissions, transfers and continued stays. Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care. Identifies potential areas of compliance vulnerability and risk; develops and implements corrective action plans for resolution of problematic issues; and provides general guidance on how to avoid or deal with similar situations in the future. Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g. overall length of stay, readmission rates, feedback from referral sources, etc.). Plays and active leadership role in the ongoing management of inpatient length of stay and utilization review across the organization.
PROBLEM SOLVING: Identifies problems or gaps in community resources that impact outcome and takes leadership role in efforts to effect changes. Takes a leadership role in identifying opportunities to reduce risks, both financial and clinical, through analysis of resource consumption outcomes.
Work Experience
Education
Master's Degree In Nursing (Preferred)
Certification / Licensure / Registration
Case Management Certification (Preferred)
Experience and Skills Required Skills:
Strong Verbal Communications Skills, Strong Written Communications Skills, Excel - Intermediate Level, PowerPoint - Intermediate Level, MS Word - Intermediate Level, Excellent Organizational Skills
Job Summary
Utilization Review coordinates the care and service of selected patient populations across the continuum. He/ she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most cost-effective use of available resources. Utilization Review assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients’ treatment and transitional needs.
COLLABORATION: Collaborates with the physician and other healthcare professionals to promote appropriate use of medical center resources. Participates as a team member to facilitate communication among all disciplines, identify barriers to meeting treatment goals, and determines ways to achieve best outcomes. Participates in the hospital Ethics Committee, as well as facilitates the hospital UR committee.
DOCUMENTATION AND MEASUREMENT: Uses established criteria to determine appropriateness of admissions, transfer and continued stays. Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/ agencies adhering to legal mandates regarding confidentiality. Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicates (e.g. overall length of stay, readmission rates, feedback from referral services, etc.).
PATIENT CARE: Uses severity of illness/ intensity of services indexes to determine appropriateness of admissions, transfers and continued stays. Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care. Identifies potential areas of compliance vulnerability and risk; develops and implements corrective action plans for resolution of problematic issues; and provides general guidance on how to avoid or deal with similar situations in the future. Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g. overall length of stay, readmission rates, feedback from referral sources, etc.). Plays and active leadership role in the ongoing management of inpatient length of stay and utilization review across the organization.
PROBLEM SOLVING: Identifies problems or gaps in community resources that impact outcome and takes leadership role in efforts to effect changes. Takes a leadership role in identifying opportunities to reduce risks, both financial and clinical, through analysis of resource consumption outcomes.
Work Experience
Education
- 4 year/ Bachelor's degree in Nursing (Required)
Master's Degree In Nursing (Preferred)
Certification / Licensure / Registration
Case Management Certification (Preferred)
Experience and Skills Required Skills:
Strong Verbal Communications Skills, Strong Written Communications Skills, Excel - Intermediate Level, PowerPoint - Intermediate Level, MS Word - Intermediate Level, Excellent Organizational Skills