• Maxim Healthcare Services
  • $88,770.00 -118,540.00/year*
  • Portland , OR
  • Healthcare - Nursing
  • Full-Time
  • 152 SW Alder St

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Under the direction of a Utilization Review Nurse Coordinator, the Utilization Review Nurse is responsible for assessment and review of the healthcare delivery system with concentration on tasks that promote cost effective quality care and cost containment in accordance with various federal and/or state statutes, regulations and guidelines.

Essential Duties and Responsibilities:
  • Performs utilization review in accordance with all state mandated regulations
  • Analyzes insurance, governmental and accrediting standards to determine criteria concerning admissions, treatment, and length of stay
  • Assures compliance with state and federal regulations and billing requirements
  • Maintains compliance with regulation changes affecting utilization management
  • Reviews patient records and evaluates patient progress
  • Ensures high standard of patient care by establishing best practice benchmarks
  • Obtains and reviews necessary medical reports and related treatment plan to conduct review
  • Reviews and validates physician s orders, reports progress, and unusual occurrences on patients
  • Ensures appropriate and cost-effective healthcare services to patients.
  • Analyzes patient records and participates in interdisciplinary collaboration with professional staff
  • Facilitates educational programs as directed to keep physicians and professional staff informed about regulations affecting utilization management
  • Recognizes and reports appropriately cases of fraud, abuse or mis-utilization
  • Consults with Social Services Department regarding the level of nursing care and collaborates with other departments in evaluation of projects affecting discharge plans
  • Supports performance improvement program
  • Performs administrative duties: receives, logs and files a variety of reports, patient charts, patient interactions, and other documents
  • Performs continuing review on medical records and identifies and evaluates need of ongoing hospitalization and services
  • Performs other duties as assigned/necessary
Minimum Requirements:
  • Current Registered Nurse license for the state in which the nurse practices
  • A Bachelor s Degree in Nursing or at least two years experience in Utilization Review preferred
  • Certification in Utilization Review or utilization Management preferred
  • Experience with Microsoft Office Suite and the ability to learn new information systems and software programs
  • Strong problem solving, project management and organizational skills with an ability to work in a fast paced environment
  • General knowledge of managed care delivery system
  • Excellent interpersonal skills, both verbal and written
  • Excellent analytical and management skills
  • Current Health Certificate (as applicable per state, federal and/or client requirements)
  • Current PPD or Chest X-Ray (as applicable per state, federal and/or client requirements)
  • Current BLS card (as applicable per state, federal and/or client requirements)
  • Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language may be required
  • Computer proficiency required
  • Must be at least 18 years of age
At Maxim Healthcare Services, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
  • Competitive pay & weekly paychecks
  • Health, dental, vision, and life insurance
  • 401(k) savings plan
  • Awards and recognition programs
*Benefit eligibility is dependent on employment status.

Maxim Healthcare Services is a leading provider of home healthcare, medical-related staffing, travel nursing, and population health and wellness services across the United States. As an established community partner, we have been making a difference in the lives of our employees, caregivers, and patients for more than 30 years. Our commitment to customer service, improving patient care, and staffing experienced healthcare professionals has paved the way for many rewarding career opportunities in the healthcare industry.

Maxim Healthcare Services, Inc. is an Affirmative Action/Equal Opportunity Employer

Associated topics: ambulatory, asn, cardiothoracic, ccu, maternal, mhb, nurse clinical, nurse rn, psychatric, unit

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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