Utilization Review Nurse

Under the direct supervision of the Supervisor, Utilization Review and Clinical Documentation Improvement, this role will be responsible for providing clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation and utilization of acute care services. This includes facilitation of appropriate physician documentation of care to accurately reflect patient severity of illness and risk of mortality. Additionally, this role will be responsible for performing utilization review of all patients presenting for hospitalization to assist in identifying patients appropriate for admission to inpatient, observation, or other patient care status. This position conducts continued stay review evaluating the medical necessity, appropriateness and efficient use of health care services of all hospitalizations (inpatient & outpatient). This role will collaborate with the health care team to optimally certify the level of care.