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Diligent Utilization Review Nurse ensuring that patients get the appropriate level of medical care. Adept at efficiently allocating medical resources while ensuring that each patient is treated fairly. Specialize in finding a balance between the fiscal needs of the hospital or medical facility and the care needs of each patient.
● Outstanding ability to assess patient needs and provide basic treatments
● Substantial familiarity with nursing procedures and medical terminology
● Extensive knowledge of medical record keeping procedures
● Ability to work well under pressure
● Impressive analytical skills
● Exceptional communications abilities
● Coordinated efforts with the utilization department to determine available resources.
● Assessed the condition of patients and recorded the basic info for each patient.
● Reported patient conditions to insurance companies and/or the appropriate agency.
● Determined the resources available to each patient.
● Provided periodic updates on patient conditions.
● Evaluated the progress of each patient and provided updates to insurance providers
● Performed utilization reviews in accordance with state and federal regulations
● Attended meetings with medical staff to finalize patient discharge plans
● Responded to calls and emails from insurance providers
● Assessed the physical and mental status of each patient
● Coordinated in-hospital and outpatient care arrangements.
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