Job Summary:
The UR nurse will review physician orders, documentation, and test results, while utilizing evidence-based tools, critical thinking skills, and nursing expertise to ensure providers have the most up to date recommendations. The recommendations and guidance provided will allow providers to develop a plan of care for the patient in the appropriate status, based on medical necessity, and guide applicable and accurate documentation to support the care provided.
Job Duties:
The ED UR nurse will help identify opportunities for performance improvement. The ED UR nurse will perform admission reviews using MCG/Indicia Care Guidelines to facilitate medical necessity. The ED UR nurse will identify actual and potential delays in service request or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays. The ED UR nurse will utilize condition code 44 guidelines when appropriate The ED UR nurse will send clinical information to payers as requested/required. The ED UR nurse will monitor all patients for medical necessity, taking necessary action to include issuing ABN’s or HINN’s and appropriately document. Assist in discharge planning resources and plans from the ED as needed. Performs other duties as assigned by supervision.
Qualifications:
Education:
â— RN licensure required. (Bachelor’s preferred).
â— BLS required.
Training and Experience:
â— 3-5 years clinical experience required.
Job Knowledge:
â— Knowledge of Conditions of Participation for Utilization Review
â— Demonstration of effective problem-solving techniques including conflict management skills
â— Demonstration of excellent oral and written communication skills
â— Excellent organizational and record-keeping skills, as well as the ability to manage multiple cases
â— Completes responsibilities in a timely manner through effective organization, setting priorities, delegation, and time management skills
â— Maintains integrity, confidentiality, and ensures compliance with WRMC’s policies and procedures, regulatory and legal requirements and current health care standards.
Essentials:
Must be able to report to work fit for duty and free of any adverse effects of illegal drugs, medical marijuana, prescription medication, and/or alcohol. Must be able to effectively communicate both orally and in writing with other individuals. Must be able to work independently, anticipate and organize workflow, prioritize, and follow through on responsibilities. Must be able to skillfully manage a high-volume caseload and to respond effectively to rapidly changing priorities
Physical Demands: Sitting, standing, walking, and lifting will occur for the majority of the shift. Must be able to lift 20 pounds. Must be able to sit/stand for extended periods of time. Fine motor skills. Visual acuity. Depth perception.