Utilization Review Nurse
职位总结：审查患者接入情况，以确定是否适当，资源利用效率和符合第三方付款人要求。任务包括分析医疗图表，确定提供护理是否在既定参数范围内。工作要求教育/经验：从认可的护士学校毕业以及五 (5) 年急诊医院临床护士经验，其中一年 (1) 年是使用管理，案例管理或临床文档改进。许可证/认证要求：内华达州有效执照作为注册护士。额外职位要求 · 经验最低3年 （三）的利用管理经验。· 在急症医疗机构中进行放弃计划的至少3年的经验。• 最近有记录的 InterQual 经验和通过 InterQual 考试的能力。· 近期有记录的 Milliman 经验。知识，技能，能力和身体要求：对：Interquel 或 Milliman 使用审查标准，医保/医疗补助指南，医院政策和程序；联合委员会认可的卫生保健组织标准，治理医院服务和健康护理的国家法规和其他相关规定和标准；临床医学和护理程序；疾病过程；部门和医院安全实践和原则；患者权利；年龄特定的病人护理实践；感染控制政策和做法；部门和病院紧急应对策略和程序。技能：解释提供治疗是否符合最佳实践，适合诊断并适当记录的患者图表；合作，协调和沟通发现的能力；为他人解释法规和标准；撰写报告，会议备忘录和其他技术文件；分析统计数据和其他量化数据；应用调查和采访技术；使用计算机和各种软件应用；与广泛的交流，建立人际关系以有效地与同事，监督者，其他工作单位的工作人员互动并交换或传递信息。物理要求和工作条件：在典型的办公室环境中工作的能力和使用标准设备，长时间坐着能力，看法阅读打印式图书
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Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.
Job Requirement
Education/Experience:
Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
Licensing/Certification Requirements:
Valid license by the State of Nevada to practice as a Registered Nurse.
Additional Position Requirements
- Minimum three (3) years of Utilization Management experience.
- Minimum of three (3) year's experience with discharge planning in an acute care facility.
- Recent documented experience with InterQual, and ability to pass the InterQual exam.
- Recent documented experience with Milliman experience.
Knowledge, Skills, Abilities, and Physical Requirements
Knowledge of:
Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.
Skill in:
Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.
Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.
Originally posted on Himalayas