Utilization Review Nurse Per Diem Remote ID-8809

January 24, 2025

JOB DESCRIPTION

The utilization review nurse is part of a team that will facilitate improvement in the overall quality, completeness, and accuracy of clinical documentation as well as appropriate clinical documentation through extensive interaction with physicians, nursing staff, case managers, other patient caregivers and Health Information Management coding staff to ensure clinical documentation reflects the clinical treatment, decisions, diagnosis and the level of service rendered. The UR nurse serves as a resource to all members of the health care team on appropriate status, documentation guidelines, provide guidance and support, as well as assisting with education and training related to improving clinical documentation on an ongoing basis.

We welcome applications from qualified applicants residing in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Massachusetts, Mississippi, Missouri, New York, North Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, Virginia, Wyoming.

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Responsibilities

Utilization Review:

Perform admission, concurrent and retrospective medical reviews to provide to the payers for reimbursement.
Functions as the liaison between various hospital departments, medical staff and payers on issues related to medical necessity for admission and continued stay.
The UR/CDI nurse maintains open, transparent and clear lines of communication with the physician advisors.
Provides UM education to clinical staff as needed.
Applies standardized criteria and guidelines to assist in the determination of appropriateness of admissions and assignment of patient class (i.e. observation, inpatient and outpatient).
Assist in monitoring wasted resources while maintaining uncompromisingly high quality of care. Responsible for maintaining and ensuring the admission process remains fully compliant with Medicare and Medicaid regulations.
Acts as a resource to Care Management department regarding utilization, insurance and payer issues.
Identifies potential problems regarding payment eligibility for clinical services and recommends corrective action.
Participates in UR meetings.

Qualifications

Minimum Education and Experience Required

Minimum education (degree/type of degree). BSN
Minimum experience (minimum years & type of experience). Minimum of 3 years of pediatric clinical experience required.
Preferred education & experience. Previous UR, case management or care coordination preferred.

Knowledge, Skills, And Abilities

Knowledge of:

Knowledge of Pathophysiology and Disease Process.
Working knowledge of clinical information.
High degree of familiarity with clinical care to establish credibility with physicians, LIPs, nurses and other members of the front-line care team.
Must be able to provide clinical and financial education to colleagues, patients and families. Critical thinking, negotiation and the ability to set priorities are of highest importance.

Skilled at:

Strong interpersonal and communication skills to manage competing priorities of the different stakeholders to ensure provision of high quality, high value and efficient care.
Electronic medical record.

Ability to:

Ability to learn/develop the skills necessary to perform Clinical Documentation review of medical records.
Ability to handle multiple priorities and increasing responsibility.
Ability to collaborate with others to achieve a common goal through mutual cooperation.
Ability to influence others for positive and productive outcomes.
Ability to quickly process complex problems, identify key components, and develop plans for resolution.
Must be able to learn and use multiple computer systems.

About Us

Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children’s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.

At Connecticut Children’s, treating children isn’t just our job – it’s our passion. As a leading children’s health system experiencing steady growth, we’re excited to expand our team with exceptional team members who share our vision of transforming children’s health and well-being as one team

Utilization Review Nurse Per Diem Remote ID-8809

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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DISCLAIMER

Other Jobs You May Be Interested In

Utilization Review Nurse Per Diem Remote ID-8809

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

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