Top 7 Utilization review nurse Jobs in Cincinnati, Oh

Discharge Planner-RN - Main Case Management - Part Time - Days
The Christ Hospital Health Network —Cincinnati, OH
- Full-time
- Acute care
- Nursing
- RN License
1d
Discharge Planner-RN - Main Case Management - PRN
The Christ Hospital Health Network —Cincinnati, OH
- Part-time
- Acute care
- Nursing
- RN License
Utilization Management (UM) Coordinator
Stepping Stone —Blue Ash, OH
- 8 hour shift
- Nursing
- RN License
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
Oasis Reviewer
Synergy Shared Services —Covington, KY
- Full-time
- Microsoft Outlook
- Computer literacy
- Mid-level
Quick Apply
MDS Nurse Transition Leader
Otterbein SeniorLife —West Chester, OH
- Nursing
- RN License
- 5 years
- Paid holidays
- Dental insurance
Quick Apply
Weekend RN - *Home Visits
Interim HealthCare —Independence, KY
- Part-time
- CPR Certification
- Management
- RN License
Quick Apply

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RN - Care Manager
Franciscan Sisters of the Poor - St. Clare Convent —Cincinnati, OH
Ability to work a flexible schedule and respond to calls / call offs. Must have a current RN License in the state of Ohio. Prepares and posts work schedules.
Quick Apply
9d
Discharge Planner-RN - Main Case Management - Part Time - Days
The Christ Hospital Health Network —Cincinnati, OH
Proficient in state of the art business trends, benchmarking, and case management tools and techniques. Knowledge and application of a wide variety of advanced…
1d

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
9d
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
9d

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utilization review nurse jobs near cincinnati, oh

Discharge Planner-RN - Main Case Management - Part Time - Days

The Christ Hospital Health Network -
Cincinnati, OH

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Job Details

Full-time
1 day ago

Qualifications

Collaborate with healthcare professionals
Database systems
Utilization review
Research methodology
Managing patients as a nurse case manager
Project management
Medical-surgical
Utilization management
Concurrent review in utilization management
Computer skills
Benchmarking
Hospital regulatory compliance
Cross-functional communication

Full Job Description

To maintain high-quality, medically necessary, evidence-based care, and efficient treatment of all patients, regardless of payment source, by ensuring the patients receive the right care, at the right time, in the right place.

Case Management Model: utilize an Integrated Case Management Model. Under this model the Case Managers will follow patients through the continuum while facilitating the functions of, care coordination, advocacy and discharge planning.

Clinical review of 100% acute bedded patients including patients admitted to Inpatient and Observation level of care at The Christ Hospital.

Monitors patients for appropriateness of continued stay, level of care and services, and quality of care using approved screening criteria.

Responsibilities specific to discharge planning including assessment, identification of specific needs, and social service intervention or referral while in the acute setting.

Awareness of services available to patients and their families upon assessment.

Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the RN Case Manager will contact the appropriate agency to meet the patient’s social, emotional and spiritual needs.

Identify/facilitate patient status from observation to inpatient as patient clinical condition warrants and communicating the information to the utilization review nurse.

Communicate with physicians when alternatives to inpatient care are indicated by clinical review.

Develop a discharge plan based on screening and assessment tools utilized by the Case Manager. Education of the discharge plan including health care recommendations to the patient, family, caregiver, and other hospital personnel

Proactively identify potential barriers to discharge, for example: alternative levels of care, financial coverage issues, psycho/social behaviors, and self-care challenges.

Work with external agencies and ancillary providers by completing discharge plans for services provided at an alternate level of care.

Facilitates daily huddles and multidisciplinary team rounds to include IS/SI, discharge plan, length of stay, barriers to discharge, and delays.

Participate in hospital based committees as requested by management.

Identifies potential delays in service or treatment and refers to the appropriate individuals within the multidisciplinary patient care teams for action/resolution.

Track and trends avoidable day information in Midas per policy.

Interfaces with patient registration, financial councilors, Social Work, and patient financial services etc. to collaborate on financial issues.

Document pertinent barriers to discharge and acceptable discharge plan weekly for admissions with high financial impact to the organization and admissions with an increased length of stay.

Identifies potential delays in service or treatment and refers to the appropriate individuals within the multidisciplinary patient care teams for action/resolution.

Track and trends avoidable day information in Midas per policy.

Interfaces with patient registration, financial councilors, Social Work, and patient financial services etc. to collaborate on financial issues.

Document pertinent barriers to discharge and acceptable discharge plan weekly for admissions with high financial impact to the organization and admissions with an increased length of stay.

Performs other duties as assigned, including but not limited to:

• Demonstrates professional responsibility in the role of an RN-Case Manager

• Complies with department and hospital policies at all times

• Maintains compliance with State/Federal Guidelines and standards

• Conforms to all requirements of Medicare

• Keep current on changing laws and requirements of Medicare/Medicaid

• Demonstrate a positive attitude at all times

KNOWLEDGE AND SKILLS:

Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.

EDUCATION: Bachelor’s Degree. Graduate of an accredited school of nursing with current licensure OR actively enrolled in a BSN program with completion within 3 years of hire date and graduate of an accredited school of nursing with current licensure.

YEARS OF EXPERIENCE: 3-5 years of medical/surgical nursing necessary, case management experience preferred

REQUIRED SKILLS AND KNOWLEDGE:

Experience with case management, utilization review, and discharge planning that is related to the clinical or operational functional areas.

·Knowledge and application of a wide variety of advanced case management tools and methods.

·Knowledge of clinical and operations research methodology and design. Proficient in state of the art business trends, benchmarking, and case management tools and techniques.

·Ability to operate PC based software programs or automated database management systems.

·Expertise in meeting regulatory and accreditation requirements.

·Strong presentation, written and oral communication skills, with strong analytical and problem-solving skills as well as time/project management skills.

·Ability to work with a variety of disciplines and levels of staff across departments and the organization is required.

LICENSES & CERTIFICATIONS:

Licensed to practice in the State of Ohio

Certified Case Management (CCM) or Accredited Case Management (ACM) desired.

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utilization review nurse jobs in cincinnati, oh

Discharge Planner-RN - Main Case Management - Part Time - Days

Discharge Planner-RN - Main Case Management - PRN

Utilization Management (UM) Coordinator

Oasis Reviewer

MDS Nurse Transition Leader

Weekend RN - *Home Visits

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