Registered Nurse - Utilization Review

About This Role

This night-shift role as a Registered Nurse in Utilization Review focuses on ensuring cost-effective, quality patient outcomes and smooth transitions. It involves determining appropriate levels of care and offering guidance, education, and support to patients. The position is within the Case Management Department at Owensboro Health Regional Hospital.

Responsibilities

• Assess complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems
• Conduct initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame
• Provide appropriate clinical information to payers as requested within specified time frame
• Collaborate with the Attending Physician, Physician Advisor, Director, Manager, or Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization and delays in services and/or discharge
• Deliver regulatory letters to patients as needed
• Work in collaboration with the interdisciplinary team to ensure quality support of care and resource information
• May assist patients/families with referrals to community agencies, post-acute providers, and/or provide education and resources
• Provide education and act as a resource for physicians, staff, and patients/families regarding case management processes
• Train new case managers, students, and interns as needed

Requirements

• Bachelor
• No experience required
• RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire
• Critical thinking skills and decisive judgment
• Works under minimal supervision
• Must be able to work in a stressful environment and take appropriate action

Important Details

• Work Hours: 11PM-7AM
• Schedule: 80 hours per pay period

About the Company

Owensboro Health Regional Hospital supports its mission, vision, core commitments, and business interests. The organization adheres to all policies and procedures, executing tasks and behaving in a manner consistent with a culture of compliance, safety, and high reliability.