The purpose of this position is to ensure that Archcare Senior Life Particpants obtain timely, cost-effective, quality care in the appropriate setting. The primary role of the Utilization Review (UR) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that our participant receive all appropriate medical services in compliance with medical and regulatory guidelines. Responsibilities include, but are not limited to, review and authorization of Outpatient Services. review of requests for pre-authorization of elective admission and procedures. inpatient admission review. review of continuing stay and discharge planning. and coordination of care and services of select member populations with common chronic conditions. In all areas, the UR Nurse is charged with managing the delivery of care in an effective, professional and compassionate manner.
Education & Experience
Associate Degree or certification equivalent
License, Registration, and / or Certification Requirement
Requires advanced knowledge of a specialized or technical field or a thorough knowledge of the practices and techniques of a professional field.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.