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Utilization Review Nurse
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Nora Concierge Care
Syracuse, NY (In Person)
$135,200 Salary, Full-Time
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Job Description
Utilization Review Nurse Nora Concierge Care Syracuse, NY Job Details Contract $65 an hour 5 hours ago Qualifications Utilization review RN License BLS Certification Utilization management Resource utilization in healthcare Full Job Description Utilization Review Nurse Shift - Day shift Overview We are seeking a dedicated and detail-oriented Utilization Review Nurse to join our dynamic healthcare team. In this vital role, you will oversee the review of patient medical records and clinical documentation to ensure appropriate utilization of healthcare services, compliance with regulatory standards, and optimal patient outcomes. Responsibilities Conduct thorough reviews of medical records, clinical documentation, and patient data using EMR systems. Collaborate with multidisciplinary teams including physicians, case managers, and coding specialists to facilitate utilization management and discharge planning processes. Apply knowledge of CPT coding, ICD-9/10 coding, DRG assignment, and medical terminology to accurately evaluate inpatient and outpatient cases across various settings. Ensure compliance with Medicare, NCQA standards, HIPAA regulations, and other relevant healthcare policies during documentation review and case assessments. Support clinical documentation improvement initiatives by identifying gaps in records that impact reimbursement or quality metrics. Maintain detailed logs of utilization review activities and communicate findings effectively to appropriate stakeholders for timely decision-making. Qualifications Current Registered Nurse (RN) license Current BLS certification Preferred experience: With level of care screening criteria such as MCG or Interqual, CMS regulations as related to hospital admissions, Utilization management or utilization review, and interfacing with health care payers/regulatory agencies. Join us to make a meaningful difference in patient outcomes through expert utilization management! We are committed to fostering an inclusive environment that supports your professional growth while ensuring you have the resources needed for success in this impactful role.