Provides professional assessment, coordination, and utilization review in accordance with all state mandated regulations. Functions as an advocate and contact person for the patient with the insurance company and outside agencies to assure continuity of care and optimal clinical and resource outcomes.
- Analyzes patient records, and participates in interdisciplinary collaboration with professional staff within designated timeframes to determine suitability of the level of care in accordance with approved Intensity of Service and Severity of Illness ( IS/SI) and/ or other established criteriia
- Performs continuing review on patients’ medical records to ensure appropriate cost efficient healthcare services to patients and their need of on-going hospitalization
- Conduct reviews and validates physician’s orders, medical reports and communicates the progress and unusual occurrences on patients to UR Supervisor and/or Hospitalist/Attending Physician
- Documents utilization review information in appropriate computer system and communicates results with claim adjusters
- Maintains Utility review and appeal logs as needed
- Advises physicians and other departments of regulations affecting utilization management
Please be advised that we are only considering nurses with the following:
- Must by a licensed Registered Nurse in the state of New York
- 2 years of clinical experience required
- Must have previous experience with utilization review
- Must know Interqual and Allscripts
Comprehensive benefits for temporary employees include:
Pathway Medical Staffing - 2 years ago
Since 1998 Pathway Medical Staffing has placed case managers and non-bedside nurses in great jobs at hundreds of leading healthcare...