Utilization Review Nurse - PRN

Are you a highly skilled and compassionate nurse looking for a flexible PRN opportunity in Utilization Review? Look no further than LifeBridge Health! Our dynamic and innovative healthcare system is seeking a Utilization Review Nurse to join our team on an as-needed basis. In this role, you will have the opportunity to utilize your clinical expertise to ensure our patients receive the most appropriate and cost-effective care. If you have a passion for improving patient outcomes and possess the required qualifications, we encourage you to apply today!

1. Conduct thorough and timely utilization reviews to determine the most appropriate and cost-effective care for patients.
2. Collaborate with interdisciplinary teams to develop and implement care plans that meet the individual needs of patients.
3. Utilize clinical expertise to assess and identify potential gaps in care and make recommendations for improvement.
4. Review medical records and documentation to ensure accuracy and completeness for reimbursement and regulatory compliance.
5. Communicate with healthcare providers and insurance companies to obtain necessary information and approvals for patient care.
6. Educate and train staff on utilization review processes and procedures to ensure compliance with regulatory standards.
7. Monitor and analyze utilization data to identify trends and potential areas for improvement.
8. Participate in quality improvement initiatives to enhance patient outcomes and reduce healthcare costs.
9. Maintain knowledge of current healthcare regulations and guidelines related to utilization review.
10. Provide support and guidance to clinical staff regarding utilization review decisions and processes.
11. Collaborate with insurance companies and other payers to negotiate coverage and reimbursement for patient care.
12. Document all utilization review activities accurately and in a timely manner.
13. Participate in interdisciplinary team meetings to discuss patient care and recommend appropriate utilization strategies.
14. Act as a liaison between patients, healthcare providers, and insurance companies to resolve any conflicts or issues related to utilization review.
15. Continuously strive to improve processes and procedures related to utilization review to enhance efficiency and effectiveness.

According to JobzMall, the average salary range for a Utilization Review Nurse - PRN in Baltimore, MD, USA is $74,000 - $94,000 per year. However, salaries may vary depending on the specific job duties, experience level, and employer. Some employers may also offer additional benefits such as bonuses, healthcare benefits, and retirement plans. It is best to research the specific job and employer to get a more accurate salary estimate.

LifeBridge Health is a nonprofit healthcare corporation that was formed in 1998 and currently operates several medical institutions in and around Baltimore, Maryland.