Registered Nurse - Utilization Review

Ascension Health is seeking a compassionate and skilled Registered Nurse to join our team as a Utilization Review Nurse. In this role, you will play a critical role in ensuring quality patient care by evaluating the medical necessity and appropriateness of hospital admissions, procedures, and treatments. We are looking for a dedicated and detail-oriented individual who is committed to upholding our mission of providing compassionate, personalized care to all patients. If you have a passion for utilizing your clinical expertise to make a positive impact in the healthcare industry, we encourage you to apply for this exciting opportunity.

1. Conduct comprehensive reviews of patient medical records to determine the medical necessity and appropriateness of hospital admissions, procedures, and treatments.
2. Collaborate with healthcare providers to ensure that treatment plans align with evidence-based practices and meet patient needs.
3. Analyze and interpret patient data and medical history to identify potential gaps in care and make recommendations for improvement.
4. Maintain up-to-date knowledge of industry standards, regulations, and guidelines related to utilization review and case management.
5. Communicate with insurance companies and third-party payers to obtain authorization for patient care and negotiate coverage for necessary treatments.
6. Serve as a patient advocate, ensuring that all decisions made regarding utilization of healthcare services are in the best interest of the patient.
7. Participate in multidisciplinary team meetings to discuss patient cases and develop comprehensive care plans.
8. Monitor and track patient outcomes and provide timely feedback to healthcare providers to facilitate continuous improvement in patient care.
9. Educate patients and their families about their healthcare options and assist with navigating the complex healthcare system.
10. Maintain accurate and detailed records of all utilization review activities and adhere to strict confidentiality guidelines.
11. Collaborate with other members of the healthcare team to identify and implement cost-effective alternatives to traditional hospitalization or treatment.
12. Demonstrate a commitment to ongoing professional development by participating in training, seminars, and continuing education opportunities.

According to JobzMall, the average salary range for a Registered Nurse - Utilization Review in Baltimore, MD, USA is $68,000 - $90,000 per year. This range can vary depending on experience, education level, and specific job duties. Some employers may offer additional benefits such as healthcare, retirement plans, and bonuses. It is important to research specific job openings and employer offers to get a more accurate salary estimate.

Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the U.S., Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. Ascension includes approximately 165,000 associates and 40,000 aligned providers. The national health system operates more than 2,600 sites of care – including 150 hospitals and more than 50 senior living facilities – in 20 states and the District of Columbia,