Utilization Review RN/Discharge Planning / Full Time / Days

Elevate your career at Wood County Hospital, where you're not just a number – you're a vital part of a team making a real difference. 

Essential Functions

• Review clinical documentation to determine medical necessity, level of care, and continued stay appropriateness in accordance with established criteria, payer requirements, and regulatory standards.
• Collaborate with physicians, nursing, case management, social work, and interdisciplinary teams to support timely care progression, discharge planning, and effective transitions of care.
• Communicate utilization review findings, authorization requirements, and coverage determinations to providers, payers, and internal stakeholders in a clear and timely manner.
• Document utilization review activities, decisions, and outcomes accurately within the medical record and designated utilization management systems to ensure compliance and audit readiness.
• Monitor and support compliance with federal, state, accreditation, and payer regulations by identifying utilization trends, participating in quality improvement initiatives, and assisting with audits and surveys.
• Prepare, prevent, protect and respond to support our culture of safety.
• Works hours per week in accordance with offer letter or per attributes of position at transfer request. May be expected to work longer hours as necessary.
• Other duties as assigned.

Requirements

Education: Diploma Nurse or ADN from an accredited School of Nursing

License: Registered Nurse in the State of Ohio

Experience: Two (2) years' acute care

Certification: BLS

Preferred

Education: None

License: None

Experience: None

Certification: None

PHYSICAL REQUIREMENTS
1. In an 8-12-hour workday, employee stands/walks (hours at one time):
[] 0-2 [x] 2-4 [] 4-6 [] 6-8 [] 8-12
2. In an 8-12-hour workday, employee sits (hours at one time/hours during the day):
[] 0-2 [x] 2-4 [] 4-6 [X] 6-8 [] 8-12
3. Employee lifts:
[x] up to 10# [] 10-20# [] 20-50# [] over 50#
4. Lifting as indicated in item 3 above is performed during the workday:
[X] occasionally [] frequently [] continuously
5. Employee uses hands for repetitive:
a. Simple grasping: [X] yes [] no
b. Pushing/pulling [X] yes [] no
c. Fine manipulation [X] yes [] no
6. Employee uses feet for repetitive movement in operating foot controls:
[] yes [X] no
7. Employee must be able to:
a. Bend [] frequently [X] occasionally [] not at all
b. Squat [] frequently [] occasionally [x] not at all
c. Kneel [] frequently [] occasionally [x] not at all
d. Climb [] frequently [] occasionally [x] not at all