Utilization Review Nurse

Position Summary

Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient’s severity of illness; and ensures compliance with the conditions of participation as they relate to utilization review and discharge planning and payer regulations.

MINIMUM EDUCATION AND EXPERIENCE:

Required:

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  Graduate of an accredited professional nursing school

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  Current Massachusetts Nursing license

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  Bachelor’s degree. - Preferred

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  5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.

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  Five years clinical nursing experience

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  Demonstrated verbal, written skills

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  Computer skills

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Preferred:

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• Master’s degree.
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