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Registered Nurse (Rn) - Utilization Review

Company

Waldo County General Hospital
Address , Belfast, 04915, Me
Employment type PART_TIME
Salary
Expires 2023-06-07
Posted at 1 year ago
Job Description

Registered Nurses with 0-3 years of experience and $20,000 for experienced Registered Nurses with greater than 3 years of experience!

  • Eligible candidates are hired (offer accepted) into a Full or Part time RN position. Bonus amount prorated for Part time hires, per diem hires are ineligible.
  • Current MaineHealth member employees are ineligible; former MaineHealth Members are ineligible until greater than 6 months separation from employment.

Position Summary (This position will consist of 24 hours per week.)

This position exercises independent judgment in ensuring that each hospital patient receives a timely concurrent review with intervention as established by the Utilization Review Plan and Social Service Discharge Plan. The Hospital Utilization Nurse will be responsible for concurrent review of all patients upon admission to Waldo County General Hospital and daily thereafter for continued medical necessity and plan of care. Provides comprehensive case management designed approach to assure appropriate allocation of the hospital's resources and promote quality patient care in the most cost effective manner. As a Utilization Review nurse the ability to coordinate comprehensive health care needs and assessments for discharge planning needs in conjunction with Social Services Discharge Planning Department.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

  • Education: A graduate from an accredited School/College of Nursing.
  • License/Certifications: Maintain active RN license in the State of Maine.
  • Experience: N/A
  • Ability to maintain confidentiality.
  • Ability to effectively communicate health care information to providers, hospital staff, reviewing Physician Advisor and insurance carriers.
  • Must be a team player with a positive attitude with self-motivation
  • Strong interpersonal skills and the ability to work effectively with all hospital staff throughout the hospital.
  • Knowledge of nursing and case management theory and practice.
  • Knowledge of current Medicare and MaineCare laws and requirements.
  • Knowledge of patient rights, denials of admission, denials for continued stay and Code Condition 44’s.
  • Strong conflict resolution and problem solving skills.
  • Knowledge of using an Electronic Health Record, utilizing accurate and timely documentation.
  • Knowledge of Utilization Review process and Discharge Planning, as to determine need for admission, discharge and continued stay medical necessity.
  • Ability to develop upon admission the implementation of utilization plan.
  • Attend daily PEP rounds to discuss and review discharge goals and plan of care.
Additional Information
MaineHealth was ranked one of America’s Best Large Employers in 2022 by Forbes!
MaineHealth is a not-for-profit integrated health system whose vision is, “Working together so our communities are the healthiest in America.” MaineHealth consists of nine local health systems, a comprehensive behavioral health care network, diagnostic services, home health agencies, and 1,700 employed clinicians working together through the MaineHealth Medical Group. With approximately 22,000 care team members, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. Learn more about our system at mainehealth.org
At MaineHealth, we offer benefits that support an individual's needs for today and flexibility to plan for tomorrow. Our packages include health and dental insurances, paid parental leave, retirement program, generous paid time off, and much more! Our comprehensive array of benefits are competitive, affordable, and include choices that meet specific, but ever changing, needs.
With a career at any of the MaineHealth locations, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the neighborhoods that surround it. We are deeply invested in the well-being of our communities and care team members. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Join us, and your abilities will be challenged and enhanced as you take your career to a new level.


Location: MaineHealth · H Utilization Review
Schedule: Part Time, Day Shift, 24