Utilization Review RN- Onsite

Job Description

We are looking for a dedicated Utilization Review RN to join our team at The University of Vermont Health Network. This onsite position will provide support to the Emergency Department at Champlain Valley Physicians Hospital in Plattsburgh, NY. The ideal candidate will be responsible for monitoring, collecting, and analyzing data to evaluate resource utilization, complications, and overall quality of care based on established practices. By utilizing these skills, the Utilization Review RN will contribute to providing optimal care in a cost-effective manner, promoting efficient use of patient services, and supporting performance improvement initiatives.

Responsibilities

• Monitor, collect, and analyze data related to resource utilization and quality of care.
• Assist in the promotion of efficient and effective use of patient services.
• Support performance improvement and quality programs.
• Coordinate internal and external resources to facilitate appropriate resource management across all age groups.
• Identifying process improvement opportunities, high-risk cases, and sentinel events.

Qualifications

• Current New York State Registered Nurse license required.
• CCM Preferred. Utilization review and discharge planning experience preferred.
• Three years of broad clinical nursing experience is required.
• Quality assurance/risk management experience preferred.
• Knowledge of interqual preferred. Knowledge of MCG a plus.
• High level of interpersonal and communication skills.
• Knowledge of coding, data collection, and analysis.
• Project management and problem-solving skills required.
• Knowledge of regulatory standards and managed care processes.
• Computer proficiency.