Job Summary
We are seeking a dedicated and experienced Travel RN-Utilization Review Specialist to join our healthcare team in Duluth. This role involves assessing and coordinating patient care utilization, ensuring appropriate hospital stays, procedures, and services while maintaining compliance with healthcare policies and regulations. The ideal candidate will possess extensive clinical expertise, including critical care, trauma, emergency medicine, and post-acute care experience. This position offers an opportunity to collaborate with multidisciplinary healthcare professionals to optimize patient outcomes and resource management across diverse clinical settings.
Duties
****Compact AND Oregon license required due to providing remote care for facilities in Oregon. Must be willing to apply for D.C license upon offer**
- Conduct comprehensive review of patient records to evaluate the necessity, appropriateness, and efficiency of care provided within various hospital departments such as ICU, emergency room, medical-surgical units, and specialty areas like pediatrics or geriatrics.
- Collaborate with healthcare providers to develop and implement discharge plans that align with clinical guidelines, insurance requirements, and patient needs.
- Utilize electronic health records (EHR) systems to document assessments, case management activities, and utilization decisions accurately.
- Monitor inpatient and outpatient services to ensure compliance with health regulation policies including HIPAA standards for patient privacy.
- Manage case reviews for diverse patient populations including trauma cases (Level I & II Trauma Centers), infectious disease management, behavioral health cases, hospice care, and home health services.
- Facilitate communication between medical teams, insurance companies, and patients to clarify treatment plans and authorization processes.
- Participate in clinical case management activities such as diagnostic evaluation, patient assessment, discharge planning, and post-acute care coordination.
- Stay informed about evolving healthcare regulations related to managed care, utilization management, and hospital medicine practices.
- Support quality improvement initiatives by analyzing utilization trends and recommending process enhancements.
Skills
- Extensive clinical background with critical care experience across ICU settings; trauma center experience (Level I & II) preferred.
- Strong knowledge of hospital medicine including emergency medicine, medical-surgical units, pediatrics (PICU), geriatrics, behavioral health, and infectious disease care.
- Proficiency in electronic health records (EHR) systems and medical terminology for accurate documentation.
- In-depth understanding of health regulation policies such as HIPAA compliance and medical records management.
- Excellent patient assessment skills coupled with the ability to evaluate physiological data such as vital signs.
- Proven ability to collaborate effectively with multidisciplinary healthcare teams to optimize patient outcomes.
- Strong case management skills including discharge planning, diagnostic evaluation, inpatient/outpatient coordination.
- Familiarity with managed care principles and utilization review processes within acute or post-acute settings.
- Effective client communication skills for engaging patients and their families during complex clinical discussions.
- Knowledge of hospital experience protocols across diverse specialties including OR procedures or home health services is advantageous.
This position is integral to ensuring high-quality patient care through meticulous utilization review while supporting hospital operations in a dynamic healthcare environment. We welcome qualified candidates committed to excellence in clinical practice and healthcare resource management.
#HC
Pay: $3,085.00 per week
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Work Location: In person
