Utilization Review Nurse

• Conducts pre-admission, concurrent and retrospective acute care, sub-acute, hospice, qualification of transitional care and long-term care needs for medical necessity

• Perform case reviews and complete all required documentation in appropriate database

• Collaborate with primary or attending physician, case managers, patient and/or family to provide continuity and quality of care in the most cost-effective manner.

• Timely completion of admission reviews (within 48-hours for weekday, 72-hours for weekend)

• Provide outpatient or pharmacy services utilization review