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Description-

The Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.

Concurrent review of patient’s clinical information for efficiency

Ongoing review of precertification requests for medical necessity

Monitor the activities of clinical and non-clinical staff

Coordinates patient’s discharge planning needs with the healthcare team

Employ effective use of knowledge, critical thinking, and skills to:

Advocate quality care and enhanced quality of life

Prevent patient complications during hospital stay

Advocate decreased hospital stay when appropriate

Maintain accurate records of all patient related interactions

Prepare monthly patient management and cost savings report

Work in an intensive, fast-paced environment with minimal supervision

Ability to stay organized and interact well with others in any situation

Provide daily updates to Manager of Utilization Management for review