RN Utilization Review

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.

RN Utilization Review / Utilization Review / Per DiemReviews patient records for medical necessity, level of care, length of stay, and authorization denials for inpatients and observation patients. Assists in the clinical appeal process. Collaborates with the healthcare team to coordinate care according to evidence-based, approved guidelines (e.g. Milliman Care Guidelines, Interqual).

MAJOR TASKS, DUTIES AND RESPONSIBILITIES
1. Serves as a resource for current standards of care, related to utilization review and case management.
2. Participates in interdisciplinary collaboration.
3. Aids with clinical decisions related to patient plans of care.
4. Develops and enforces policies and procedures for the hospital related to compliance with regulatory and accreditation agencies, and other county, state, and federal agencies.
5. Utilized applicable criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning (e.g. Milliman Care Guidelines, Interqual).
6. Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in hospital to comply with government and insurance company guidelines.
7. Monitors and makes recommendations for appropriate utilization of resources using evidence-based clinical criteria.
8. Other duties as assigned

EDUCATION, TRAINING AND EXPERIENCE

• Graduate of an accredited program for nursing education, Bachelor's degree in Nursing (BSN) preferred.
• Current licensure to practice professional Nursing in the State of Ohio.
• Current American Heart Association (AHA) Healthcare Provider CPS (BLS) certification required.
• Minimum of three years acute care nursing experience required.

Benefit Summary:

Join our team, and you'll have access to a cutting-edge facility with state of the art technology. You'll also interact with some of the region's top notch healthcare professionals. You'll find plenty of opportunities to grow and advance your career.

We'll also reward your hard work with:

• Great health, dental and vision plans
• Competitive wages
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• Generous short term and long term disability plans
• Employer-matched 403(b)
• Employer sponsored cash balance pension plan
• Vacation and Holiday time
• Generous tuition reimbursement
• And a lot more

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