The Utilization Review Registered Nurse is responsible for the utilization review of assigned patients for an organized, multidisciplinary team approach and assures quality, cost-efficient care. Functions as 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. Provides nursing assessment, planning, and coordination of care.
- BSN in Nursing preferred
- Current Pennsylvania RN Licensure
- 3 years clinical oncology experience
- 1 year experience in Utilization Review and/or similar role. 2-3 years preferred
- Strong organizational, clinical and communication skills
- Discharge Planning/Case Management experience
- Knowledge and experience with Milliman criteria
- Must have working knowledge of basic computer programs (Word, Excel), and ability to learn programs and function of EHR
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