Utilization Review Nurse - PT - Varied Shift - Erie County Medical Center : Job Details

Facilitates a process of assessment, planning and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost effective care; Validates appropriate level of care (severity of illness), efficient and effective care delivery (intensity of services) and safe discharge to the next appropriate level of care; Conducts admission and concurrent review using current evidence-based clinical decision support criteria; Completes full assessment of plan of care to determine if criteria are met to ensure third party reimbursement; Enters data into utilization data base; Conducts clinical chart reviews; gathers clinical information to assess and expedite care needs; Discusses cases with treating physician(s) and other healthcare professional to better understand plans-of-care; Identifies and evaluates delays in care; Initiates a discharge planning and readmission prevention plan when applicable; Approves bed days for inp...Behavioral Health, Nurse, Medical Director, Shift, Healthcare, Patient, Registered