Utilization Review Nurse - Weekends

Type of Position: Management - Operations
Work Shift: Regular
Institution Name: University of Arkansas for Medical Sciences

About the role

The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans.

Benefits

• Health: Medical, Dental and Vision plans available for qualifying staff and family
• Holiday, Vacation and Sick Leave
• Education discount for staff and dependents (undergraduate only)
• Retirement: Up to 10% matched contribution from UAMS
• Basic Life Insurance up to $50,000
• Career Training and Educational Opportunities
• Merchant Discounts
• Concierge prescription delivery on the main campus when using UAMS pharmacy

Summary of Job Duties

The Utilization Review (UR) RN Care Manager is responsible for utilizing pre-established, evidence-based screening criteria to validate the appropriateness of patient admissions, provide screening, and continuous observation status monitoring. The RN Care Manager UR is also responsible for communicating relevant information to appropriate payer carriers regarding a patient’s stay. The role reflects appropriate knowledge of the RN scope of practice, current state requirements, CMS Conditions of Participation, Patient Bill of Rights, AB 1203 and other Federal or State regulatory agency requirements specific to discharge planning.

Responsibilities

• Initiates appropriate referrals to internal and external interdisciplinary teams.
• Establishes a working diagnosis on every patient at the time of the initial review.
• Communicates the target length of stay and estimated discharge on every patient at the time of the initial review and coordinates the discharge planning process in collaboration with the interdisciplinary team.
• Documents all team, physician, and payer communication and concerns pertaining to coordinating of care and services.
• Responsible for utilizing pre-established evidence-based screening criteria to validate the appropriateness of patient admission and provide appropriate screenings of the patients assigned to a designated coverage area, including initial, continued stay and completion of discharge screens.
• Communicates with physicians regarding the level of care or admission status when appropriate criteria are not met for inpatient, observation, or continued stay review.
• Escalates appropriate cases to Physician Advisor for secondary review process.
• Escalates payer denial/appeal issues to the Physician Advisor/CMO/Attending in a timely fashion.
• Other duties as assigned to meet UAMS core values and the business needs of the department.

Requirements

Minimum Qualifications:

• Associate’s Degree in Nursing (ADN)
• 5 years of clinical nursing experience
• Valid AR Registered Nursing license

Preferred Qualifications:

• Certified Case Manager (CCM) or American Case Management (ACM) certification

Physical Requirements

• Stand: Frequently
• Sit: Frequently
• Walk: Occasionally
• Bend, crawl, crouch, kneel, stoop or reach overhead: Frequently
• Lift and carry weight: 25 lbs
• Push and pull weight: 25 lbs
• Use hands to touch, handle or feel: Frequently
• Talk: Continuously
• Hear: Continuously
• Taste or smell: Occasionally
• Read, concentrate, think analytically: Continuously

Constant Physical Activity: Hearing
Frequent Physical Activity: Feeling, Manipulate items with fingers, including keyboarding, Sitting, Standing, Talking, Walking
Occasional Physical Activity: Balancing, Crawling, Crouching, Grasping, Kneeling, Reaching, Stooping

Pre-employment Screening Requirements

• Annual TB Screening
• Criminal Background Check
• Substance Abuse Testing

This position is subject to pre-employment screening (criminal background, drug testing, and/or education verification). A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity. The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law.

Required Documents to Apply: License or Certificate (see special instructions for submission instructions), Resume
Optional Documents: Proof of Veteran Status