Utilization Review Nurse

Job Description

The Utilization Review Author will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Author will determine the appropriate cases for review, utilizing client specific guidelines. Upon identification of a case, the Utilization Review Author will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria. The successful candidate must have hospital-based Utilization Review or Case Management experience.

Responsibilities:

·Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care

·Abstract data from a variety of medical records to ensure accurate clinical data

·Adhere to established quality, timeliness, and productivity outputs required in the completion ...