UR Tech / Nurse

Virginia Gay Hospital, Clinics, Home Health, Nursing and Rehab

GENERAL STATEMENT OF DUTIES:

The Utilization Review Tech/Nurse is responsible for the utilization review for preadmission screenings of patients, monitoring of patient status/needs, and notification of third party payors, precertification of outpatient procedures, medication preauthorization and auditing charts as requested. The UR Tech/Nurse is responsible for the InterQual review of charts to assist with determination of appropriate level and length of stay.

ESSENTIAL DUTIES:

Duties are listed below and as delineated in the UR Tech/Nurse's Performance Review:

  • Completes the utilization review process for preadmission screenings of patients, monitors patient status/needs, notifies third party payer and completes preauthorization for outpatient procedures and patient medications. Also responsible for UR QI projects and data collection; and monitoring of patient length of stay to remain in compliance with CAH regulations.
  • Audits charts as requested.
  • Functions as facility InterQual site administrator and reviews cases with InterQual software/criteria as needed.
  • Develops and maintains written utilization review policies and procedures.
  • Assists with developing and maintaining written policies and procedures for Utilization Review.
  • Demonstrates knowledge of safety and infection control policy/procedures as it pertains to the UR position. Participates in monitoring quality of utilization.

*Experience is required!

Applying for:

UR Tech/Nurse

Virginia Gay Hospital, Clinics, Home Health, Nursing and Rehab

(.DOC, .DOCX, .PDF, .RTF, .TXT, .ODT, .PAGES, .WPS up to 2MB)

Job ID: 72063

Posted 19 days ago

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