Utilization Management Nurse (Hybrid)

Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in: Support of positive patient health care outcomes, Increased patient/health care team outcomes and satisfaction, Improved inpatient throughput and appropriate length of stay, Improved communication, awareness and adherence to regulatory requirements associated with utilization management, Support for appropriate level of care and decreased inpatient bed day denials, Continuity and coordination of care, Appropriate and timely authorization for level of care, Decreased denials, Appropriate reimbursement. Performs timely and accurate admission and continued stay review in accordance with department policy to ensure efficient use of hospital resources, timely discharge and optimal, appropriate reimbursement. Documents review activity, including application of criteria or policy, clinical review to submit to insurance providers, outcomes and cost savings.