Clinical Information, Clinical Laboratory, Clinical Outcomes, Documentation Plan, Health Plan, Healthcare, Maintain Compliance, Medical Records, Patient Assessment, Patient Care, Patient Education, Quality Assurance, Quality Management, Quality of Care, Registered Nurse (RN), Regulatory Compliance, Resource Utilization, Time Management, Treatment Plan, Utilization Management
Overview
A Utilization Review (UR) RN job involves assessing patient medical records and treatment plans to ensure care is medically necessary, appropriate, efficient, and cost-effective, working with providers and insurers to approve services, manage length of stay, prevent unnecessary procedures, and facilitate smooth transitions, often involving prospective, concurrent, and retrospective reviews
Job Details:
- Position: Utilization Review RN
- Contract: 13 weeks contract job with possible extensions
- Shift: 5X8 hours Day Shifts (08:30 AM to 05:00 PM)
- Shift Notes: Rotating Weekends
- Weekly Hours: 40 hours per week
- Facility name: Kaiser Foundation Health Plan of Georgia
- Facility location: 9 Piedmont Center, 3495 Piedmont Rd., NE, Atlanta, GA 30305
Responsibilities
- Conduct utilization review of patient cases to ensure quality of care and appropriateness of services provided
- Collaborate with physicians and healthcare professionals to develop and implement patient care plans
- Evaluate healthcare resource utilization and identify opportunities for improvement
- Review medical records, lab results, and other clinical information to ensure compliance with established standards and guidelines
- Provide complex clinical information to insurance carriers and healthcare providers to support reimbursement decisions
- Document patient care plans and utilization review activities in a timely and accurate manner
- Participate in ongoing quality improvement initiatives
- Educate patients and families about healthcare services and resources
- Other duties as assigned