Utilization Review Nurse (0.9 FTEDays)
Share
Job Location:
Bellevue, WA - USA
Monthly Salary:
$ 51 - 77
Posted on:
18 days ago
Vacancies:
1 Vacancy
Job Summary
Welcome to a medical center where youre the center of attention.
Pay range:
-
Hourly$51.79 - $77.69Utilization Review Nurses collaborate with the care team across the continuum to assure high quality safe and cost effective patient care. Utilization Review Nurses drive adherence to regulatory and payer guidelines and work in partnership with Social Workers to assure appropriate continuity of care before during and after hospitalization.
Performs preadmission admission and continued stay reviews to ensure appropriate patient class and medical necessity of all observation and acute care hospitalizations.
Utilizes clinical knowledge and expertise to assure patients are receiving the right care at the right time.
Intervenes with physicians nursing social work and ancillary departments to resolve delays in service inappropriate patient class or quality of care issues.
Follows up with attending physicians when patients do not meet MCG criteria and/or clinical criteria that supports acute care hospitalization/observation. Utilizes Physician Advisor when contact with the attending physician has not resulted in resolution.
Acts as a consultant to educate patients families and staff regarding Medicare/Medicaid guidelines compliance with external review organizations and potential alternatives to acute care hospitalization.
Maintain assigned work queues such as discharges short stays prior authorization etc
Reviews all observation cases to ensure appropriate setting admissions or timely discharge.
0.9 FTE - 36 hours per week
Qualifications:
Associates degree in nursing required. Bachelors or Masters in nursing preferred.
Current Washington State license as a Registered Nurse required. Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification preferred. For incumbents hired prior to December 1 2014 an LPN license plus five years of additional experience is acceptable.
Three years acute care experience required. Prior utilization management case management compliance or payer experience required.
Ability to effectively present information and respond to questions from groups of managers patients physicians and payors.
Knowledge of word processing spreadsheet database and presentation software.
Why join Overlake
- Local visible leaders who care about you.
- A values-based work environment.
- Medical insurance premiums as low as $0 per month.
- Many Overlake services covered at 100%.
- Tuition reimbursement up to $10000 per year.
- Generous retirement plan matching starting at 5% and increasing to 7% after five years with immediate vesting.
- Pre-tax and Roth after tax retirement savings plans.
- An expanded Employee Assistance Program.
- A caregiver support program to help with everything from childcare to eldercare.
- Free parking and Orca transit passes.
If this sounds like an environment where youll thrive wed love to hear from you.
How much will this job pay
Posted pay ranges represent the entire pay scale from minimum to maximum. For jobs with more than one level the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional pay based on shift certification or level of education. Job offers are determined based on a candidates years of relevant experience and internal equity. If you have questions about Overlakes pay practices employee benefits or the pay for a specific position please contact
Required Experience:
IC
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Dermal Fillers
- Experience Administering Injections
- Home Care
- Nursing
- Botox Experience
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
Overlake is a nonprofit serving Seattle’s Eastside community with a 349-bed hospital and a network of primary care, urgent care, and specialty clinics.
