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Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services.
*This is not a remote position*
Education:
Associates Degree in Nursing. Bachelor’s Degree in Nursing preferred.
Evidence of continuing professional development
Licensure/Certification/Registry:
Current RN licensure in the State of Illinois required
Experience:
Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review experience strongly preferred.
Other Knowledge/Skills/Abilities:
Understanding of healthcare reimbursement mechanisms preferred.
Strong oral and written communication skills.
Demonstrated adaptability to changes in health care environment with proactive problem solving attitudes
Understanding of the principles of performance improvement, team collaboration, and conflict resolution
Full Time
Hospital
$75k-93k (estimate)
04/14/2024
04/12/2025
memorialhealth.com
YORK, PA
25 - 50
1955
BRENDA L BARSHINGER
<$5M
Hospital
Memorial Health University Medical Center (MHUMC) is a 612-bed hospital in Savannah, Georgia. We opened our doors in 1955 and have evolved into the most advanced healthcare provider in the region. We are a regional referral center for heart care, cancer care, trauma care, children's care, high-risk pregnancies and high-risk newborn care. Our hospital includes the region's only Level 1 trauma center, the region's only children's hospital and the Savannah campus of Mercer University School of Medicine. Memorial Health is part of HCA Healthcare. HCA Healthcare has been continually named a World's ...
Most Ethical Company by Ethisphere since 2010. In 2019, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
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The job skills required for Utilization Review Nurse include Patient Care, Health Care, Acute Care, Collaboration, Problem Solving, Quality Improvement, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Nurse positions, which can be used as a reference in future career path planning. As an Utilization Review Nurse, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Nurse. You can explore the career advancement for an Utilization Review Nurse below and select your interested title to get hiring information.