Nurse Case Manager/Utilization Review Nurse

We are seeking a dedicated and knowledgeable Utilization Review Nurse to join our healthcare team for a six-week contract. The ideal candidate will possess a strong background in patient care and utilization management, particularly in a hospital setting.

This role involves reviewing patient cases to ensure compliance with established standards, guidelines, and regulations, including Medicare requirements. The Utilization Review Nurse will play a critical role in optimizing patient outcomes while maintaining the integrity of clinical services.

*** Responsibilities ***

Conduct thorough reviews of patient records to assess the appropriateness of care provided in accordance with established standards and guidelines.* Collaborate with healthcare providers to ensure that all aspects of patient care meet quality and compliance benchmarks.* Utilize ICD-10 and ICD-9 coding systems to accurately document diagnoses and treatment plans.* Engage in discussions with clinical staff regarding utilization management practices and recommend improvements as necessary.* Maintain up-to-date knowledge of healthcare regulations, policies, and best practices related to hospice care and patient management.* Analyze data related to patient outcomes and resource utilization to support quality improvement initiatives.* Provide education and support to clinical staff regarding utilization review processes and standards.

*** Qualifications ***

Current nursing license required; experience in hospital setting is highly desirable.

* Strong understanding of utilization management principles and practices.

* Proficiency in ICD-10 and ICD-9 coding systems.

* Excellent knowledge of physiology and medical terminology relevant to patient care.

* Ability to work collaboratively within a multidisciplinary team environment.

* Strong analytical skills with attention to detail for accurate case reviews.

* Exceptional communication skills, both verbal and written, for effective interaction with healthcare professionals and patients.

Join our team for a six-week contract as a Utilization Review Nurse where you can make a significant impact on patient care while ensuring compliance with industry standards.

Job Types: Full-time, Contract, Temporary

Pay: $50.00 - $52.00 per hour

Expected hours: 40 per week

Schedule:

Work Location: In person