Job Description

Job Title: Licensed Practical Nurse - Utilization Review
Job ID: 697309
Status: Full-Time
Regular/Temporary: Regular
Hours: 7a -3:30 p, Monday - Friday
Shift: Day Job
Facility: UPMC Susquehanna Williamsport
Department: Utilization Review
Location: 700 High Street, Williamsport PA 17701

Description

UPMC Susquehanna is currently seeking a Licensed Practical Nurse to function as a Utilization Review Nurse! One in this role will review the medical necessity of inpatient and outpatient hospitalizations in accordance with the established standards of the UPMC Susquehanna and third party payors. Report any deviations and initiate the appropriate appeal process.


Responsibilities:
  • Performs pre-admission review of all admissions to the Comprehensive Rehabilitation program.
  • Facilitates appropriate patient placement through compliance with the placement policies and procedures.
  • Reviews all urgent/emergent admissions for medical necessity and emergency pre-certification requirements within one working day.
  • Completes concurrent reviews, relays all pertinent patient information and secures authorization for needed additional patient services on all inpatients in accordance with the care criteria requirements of third party payors. 
  • Initiates the appeal process in cases of denied payment from payors following third party mandated procedures.Communicates with physicians regarding admission necessity, need for documentation of criteria justifying continued stay and anticipated discharge.
    Serves as a resource to physicians, physician office staff, social service, case managers and other hospital disciplines in regard to insurance benefits and managed care processes.
    Compiles, maintains and completes accurate report of all Utilization Review, Comprehensive Rehab and CRS statistics on a monthly basis in accordance with policies and procedures.
     Reports all variances to the Manager or designee in his/her absence.

Qualifications

Completion of a Practical Nursing Program approved by the State Board of Nursing. Excellent communication skills necessary to effectively interact with patients, family members, visitors and staff members. Basic computer skills necessary to input patient care orders and medical record documentation.

 

Two years inpatient acute care nursing experience or equivalent experience in health care related or Utilization Review activities strongly preferred.



Licensure, Certifications, and Clearances:
CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire

  • Basic Life Support or Cardio Pulmonary Resuscitation
  • Licensed Practical Nurse
  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $16.98 to $25.48

Union Position: No

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