Utilization Review Nurse

Company Name:
Samaritan Pacific Community Hospital
Utilization Review Nurse
Department: PCH SOCIAL SVCS/CASE MGT
Schedule: 1.0 (80 hrs/pp)
Shift: Day
Hours: Variable
Weekend Required: Rotating
Job Details:
Reviews hospital admissions for medical necessity and conducts concurrent reviews of all patients regardless of financial class. Responsible for untilization reviews to ensure correct admission status is ordered and length of stay is appropriate. Provides appropriate information to physicians related to required documentation elements. Documents all clinical reviews in Midas, utilizing interqual screening criteria.A Baccalaureate Degree in Nursing preferred.Three (3) years of hospital nursing experience care utilization review, discharge planning or case management experience preferred.Utilization Review or Case Management Certification preferred.
Three (3) years of RN experience required.
An understanding of health care, health care delivery systems, managed care and a basic knowledge of utilization review, case management and health information systems required.
A working knowledge of insurance benefits or covered services including Medicare and Medicaid required.
OR RN License required or eligible
Weekend requirement - Rotating
Willing to work in Newport, OR
Requisition #: 23537
Overtime Rule: 40
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