What are the responsibilities and job description for the Utilization Review RN/Discharge Planning / Full Time / Days position at Wood County Hospital Assn?
Elevate your career at Wood County Hospital, where you're not just a number – you're a vital part of a team making a real difference.
Utilization Review RN/Discharge Planning / Full Time / Days The Utilization Review Nurse ensures the appropriate utilization of hospital services by conducting clinical reviews to support medical necessity, regulatory compliance, efficient care progression, and safe transitions of care across the continuum. The Utilization Review Nurse is an onsite position.Essential Functions
- Review clinical documentation to determine medical necessity, level of care, and continued stay appropriateness in accordance with established criteria, payer requirements, and regulatory standards.
- Collaborate with physicians, nursing, case management, social work, and interdisciplinary teams to support timely care progression, discharge planning, and effective transitions of care.
- Communicate utilization review findings, authorization requirements, and coverage determinations to providers, payers, and internal stakeholders in a clear and timely manner.
- Document utilization review activities, decisions, and outcomes accurately within the medical record and designated utilization management systems to ensure compliance and audit readiness.
- Monitor and support compliance with federal, state, accreditation, and payer regulations by identifying utilization trends, participating in quality improvement initiatives, and assisting with audits and surveys.
- Prepare, prevent, protect and respond to support our culture of safety.
- Works hours per week in accordance with offer letter or per attributes of position at transfer request. May be expected to work longer hours as necessary.
- Other duties as assigned.
Requirements
Education: Diploma Nurse or ADN from an accredited School of Nursing
License: Registered Nurse in the State of Ohio
Experience: Two (2) years' acute care
Certification: BLS
Preferred
Education: None
License: None
Experience: None
Certification: None
PHYSICAL REQUIREMENTS
1. In an 8-12-hour workday, employee stands/walks (hours at one time):
[] 0-2 [x] 2-4 [] 4-6 [] 6-8 [] 8-12
2. In an 8-12-hour workday, employee sits (hours at one time/hours during the day):
[] 0-2 [x] 2-4 [] 4-6 [X] 6-8 [] 8-12
3. Employee lifts:
[x] up to 10# [] 10-20# [] 20-50# [] over 50#
4. Lifting as indicated in item 3 above is performed during the workday:
[X] occasionally [] frequently [] continuously
5. Employee uses hands for repetitive:
a. Simple grasping: [X] yes [] no
b. Pushing/pulling [X] yes [] no
c. Fine manipulation [X] yes [] no
6. Employee uses feet for repetitive movement in operating foot controls:
[] yes [X] no
7. Employee must be able to:
a. Bend [] frequently [X] occasionally [] not at all
b. Squat [] frequently [] occasionally [x] not at all
c. Kneel [] frequently [] occasionally [x] not at all
d. Climb [] frequently [] occasionally [x] not at all