Utilization Review RN

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization. Monitors documentations for accuracy and clinical compliance. Organizes and coordinates activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines.

1. Performs medical necessity reviews for selected procedures and services.
2. Provides timely and thorough case screening to identify case management needs and make appropriate referrals to case managers.
3. Collaborates with members/designees, families and members of the health care team to maximize outcomes.
4. Identifies discharge needs and collaborates with health care providers to facilitate a timely discharge to an appropriate level and location of care.
5. Educates providers and members to promote self-care and self-advocacy.
6. Realizes positive outcomes in terms of the quality, safety and cost-effectiveness of health care services provided.
7. Responds to outstanding utilization management issues and inquiries made via overnight voicemail and /or emails.
8. Develops and maintains cooperative relationships with other parts of the organization. Consults with colleagues/experts as needed.
9. Develops and maintains cooperative relationships with other parts of the organization. Consults with colleagues/experts as needed.
10. Performs related duties, as required.

Graduate from an accredited School of Nursing. Bachelor’s Degree in Nursing, preferred. 

Must be enrolled in an accredited program within 24 months of employment, if hired after September 1, 2010 and obtain a BSN Degree within five (5) years of employment date.

Minimum of five (5) years clinical experience, required. Previous experience in case management, disease management, quality management or patient education, preferred.

To apply for this position submit your resume through this link:

http://jobs.northwell.edu/job-3/7480228/care-connector-utilization-nurse-greenvale-ny/#tab-id-1