Utilization Review RN

Community Health Systems - Birmingham, AL

Job Title: Utilization Review RN

Position: Registered Nurse Care Manager

Job Type:

Pay:

Shift:

Work Type:

Location

Address:

City: Birmingham

State: AL

ZIP Code:

Job Responsibilities

Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services.
Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues.
Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs.
Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions.
Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards.
Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.
Performs other duties as assigned.
Complies with all policies and standards.

Required Skills

Core Skills

Strong understanding of case management principles, discharge planning, and transitions of care.
Knowledge of federal, state, and Joint Commission standards related to case management.
Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams.
Ability to assess complex situations, identify solutions, and implement care plans efficiently.
Proficiency in electronic medical records (EMR) and documentation systems.
Strong organizational and time management skills to prioritize tasks in a dynamic environment.

Preferred Skills

Not specified

Requirements

Experience: 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required; 2-4 years of care management experience preferred.

Education: Associate Degree in Nursing required; Bachelor's Degree in Nursing preferred.

License & Certification: