Utilization Review Nurse

This job is no longer active. View similar jobs.

POST DATE 9/18/2016
END DATE 11/9/2016

UHS of Delaware Inc. - Corporate Office KING OF PRUSSIA, PA

AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Associates Degree


Universal Health Services, Inc. (UHS) knows what it
takes to lead, inspire and succeed. One of the nation s
largest and most respected hospital companies, UHS owns
and operates through its subsidiaries acute care
hospitals, behavioral health facilities and ambulatory
centers in the United States, Puerto Rico, the U.S.
Virgin Islands and the United Kingdom.
UHS built an impressive record of achievement and
performance, steadily growing from a startup company
with zero revenue into a Fortune 500 corporation with
annual revenue that exceeds $9 billion. The company's
operating philosophy has proven to be effective: Build
or acquire high quality hospitals in rapidly growing
markets, then invest in the people and equipment needed
to allow each facility to thrive and become a dominant
healthcare provider in its community.
Headquartered in King of Prussia, PA, UHS ranks on the
Fortune 500 list of America's largest corporations with
over 74,000 employees, and is consistently listed among
Fortune's "Most Admired Companies and one of the 30
Most Meaningful Companies To Work For in America by
Business Insider.
As a member of the UHS Acute Care Division Patient
Admission Review Center, supports hospitals in making
patient status determination and proper documentation of
the patient s clinical presentation and diagnosis.
Reviews the clinical data presented by the hospital and
applies evidence based clinical decision support tools
to identify options for level of care determinations and
corresponding documentation standards. Advises hospitals
on applicable patient status criteria and documentation
practices that would substantiate the status
determination, with clinical decision-making and patient
status determinations remaining at all times with the
treating providers and hospital at which the patient is
located. Collaborates with the treating physician to
ensure the patient is placed in the most appropriate
status based on the clinical indications documented in
the medical record.
Essential Job Duties:
Performs independent, criteria based, documentation
assessment, via medical record review and discussion
with the physician as needed, on all patients referred.
Applies clinical criteria and guidelines to advise on
appropriateness of admission based on the use of
relevant evidence based clinical decision support tools
and Medicare regulations and guidelines as appropriate.
Accurately correlates clinical based data to hospital
approved criteria set.
Applies best practice and standards in the Utilization
Review Entry (URE) application of Midas, and as needed
within the electronic medical record that supports the
appropriate level of care.
Collaborates with the physician when documentation
presented does not meet evidenced based medical
necessity guidelines to substantiate the patient s level
of care status selection.
Works directly with the physician advisor to obtain
recommendations on cases that require additional
information to ensure level of care assigned is
clinically appropriate.
Documents interactions and outcomes with physician
advisors in the appropriate area in Midas.
Acts as a resource to the Emergency Department
physicians for any issues related to appropriate status
assignment of patients.
Maintains up to date knowledge regarding changes within
the evidence based clinical decision support tool.
Participates in Quality Reviews and Inter Rater
Reliability processes and achieves performance results
at or above thresholds established by management.
Associates Degree with a minimum of 5 years experience.
Case Management experience, and/or Utilization Review,
Utilization Management skills in a clinical setting
RN with nursing experience in related clinical
setting, preferably critical care (ER, ICU) strongly
Computer proficient with strong typing skills in
Microsoft applications specifically Microsoft Word and
Working knowledge of current evidence based clinical
decision support tools with the ability to apply the
criteria consistently and accurately (Interqual
experience preferred).
Ability to accept ownership and accountability for
compliance with CMS and UHS best practice guidelines.
Ability to prioritize, problem solve and multi-task.
Proficiency in utilizing clinical software programs
and electronic medical records.
Proficient understanding of patient care cost and
reimbursement information.
Excellent phone and communication skills and ability
to convey key concepts succinctly and clearly.
Day, evening and night shifts available
Ability to work every other weekend
Potential to work remotely
This position offers a challenging work environment,
growth and development; if you are looking for a
rewarding career, please take a moment to share your
background with us by applying online. UHS offers
competitive compensation commensurate with experience
and benefits programs including medical, dental, life
insurance and 401k.
*UHS is a registered trademark of UHS of Delaware, Inc.,
the management company for Universal Health Services,
Inc. and a wholly-owned subsidiary of Universal Health
Services, Inc. Universal Health Services, Inc. is a
holding company and operates through its subsidiaries
including its management company, UHS of Delaware, Inc.
All healthcare and management operations are conducted
by subsidiaries of Universal Health Services, Inc. To
the extent any reference to "UHS or UHS facilities" on
this website including any statements, articles or other
publications contained herein relates to our healthcare
or management operations it is referring to Universal
Health Services' subsidiaries including UHS of Delaware.
Further, the terms "we," "us," "our" or "the company" in
such context similarly refer to the operations of
Universal Health Services' subsidiaries including UHS of
Delaware. Any employment referenced in this website is
not with Universal Health Services, Inc. but solely with
one of its subsidiaries including but not limited to UHS
of Delaware, Inc.
UHS is not accepting unsolicited assistance from search
firms for this employment opportunity. Please, no phone
calls or emails. All resumes submitted by search firms
to any employee at UHS via-email, the Internet or in any
form and/or method without a valid written search
agreement in place for this position will be deemed the
sole property of UHS. No fee will be paid in the event
the candidate is hired by UHS as a result of the
referral or through other means.