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RN Utilization Review Specialist

Infirmary Health
Full-time
Remote
United States
Utilization Review

Overview

Qualifications

Minimum Qualifications:

 

Associate Degree in Nursing

 

2 of the most recent 4 years’ working in an acute care setting

 

Proficient in word processing and PC based spreadsheet programs

 

Licensure, Registration, Certification:

 

One of the following:

  • Current Alabama RN license
  • Current Multi State RN License in accordance with Nurse Licensure Compact (NLC) for Alabama*

*Infirmary Health abides by the NLC requirements and guidelines for the state of Alabama

 

For specific areas CRRN (Certified Rehabilitation RN) is required (or eligibility)

 

Desired Qualifications:

 

BSN

 

Some background in management, clinical education or case management

 

Desired Licensure, Registration, Certification:

 

National certification applicable to area of clinical practice

Responsibilities

Improves overall quality and completeness of clinical documentation by performing concurrent review of the medical record to ensure medical necessity and appropriateness of hospital admissions.  Provides education to physicians and others to improve the capture of clinical severity for the level of service rendered.  Identifies process improvement opportunities and supports the timely and accurate capture of measurements to improve patient outcomes.