RN/Registered Nurse - Utilization Review - PRN

  • Company: Hospital Corporation of America
  • Location: Richmond, Virginia
  • Posted: November 09, 2017
  • Reference ID: 00448-39882
Description:
The Registered Nurse is r esponsible for assessing, planning, implementing, evaluating and documenting all aspects of patient care. He/she will work closely with all health care providers to facilitate and coordinate efficient, effective, quality health care. The individual must demonstrate knowledge of the principles of growth and development over the appropriate life span; possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his or her age-specific needs; and, have the ability to provide care needed by the pertinent patient group(s). He/she will implement and/or comply with all the policies, procedures and standards of the unit, department and the institution.

SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS*
  1. Demonstrates clinical competency to practice on the Behavioral Health Unit
  2. Communicates effectively with staff, peers, management, internal and external customers.
  3. Completes insurance reviews timely and in accordance with requirements
  4. Works collaboratively with community services boards for funding for uninsured patients
  5. Reviews charts to ensure inpatient admission compliance/asses for discharge needs
  6. Collaborates with social workers and physicians on patient denials
  7. Keeps healthstream up to date
  8. Completes Interqual training yearly
  9. Documents all documentation in the MIDAS system
  10. Documents needed information in the Interqual system
  11. Acts as a resource for staff

Qualifications:
EXPERIENCE
Required - Graduate of an accredited school of nursing, BSN preferred OR Masters level clinician

Preferred - One year of insurance review experience

EDUCATION
Required - Graduate of an accredited nursing program; Current licensure as a Registered Nurse in the Commonwealth of Virginia or compact state OR a Masters degree in a human service field

Preferred - Bachelor's degree nursing from an accredited nursing program

LICENSURE
Required- Current Virginia state license required OR Masters level clinician
Preferred- Psychiatric Certification Preferred

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