Registered Nurse, Transplant Utilization Review
Q
Quantum HealthHealthcare Navigation
Dublin, OH / RemoteFull-TimeMiddle
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of 2 years clinical experience with direct patient care required in a hospital setting
- Required Skills
- Microsoft OfficeCritical thinking
Requirements
- Active, unrestricted, and unencumbered professional license (RN, LCSW, LPC, PharmD, or other qualified healthcare professional).
- Must hold or obtain Multi-State License (MSL) or additional state licenses within 90 days of hire.
- Minimum 2 years of clinical experience with direct patient care in a hospital setting.
- Experience in health management preferred.
- Experience in transplant preferred.
- Strong critical thinking and clinical decision-making skills.
- Proficiency with computer systems, navigation of multiple platforms, and Microsoft applications.
- Ability to work independently with limited supervision.
- Excellent verbal and written communication skills.
- Ability to multitask and prioritize in a fast-paced environment.
Responsibilities
- Assess and review requests for transplant inpatient medical services and transitions.
- Conduct initial clinical, concurrent, and retrospective reviews.
- Utilize adopted clinical criteria and document outcomes in the authorization database.
- Facilitate discharge planning, including arrangements for skilled nursing, rehabilitation, and home health services.
- Communicate outcomes to patients, providers, facilities, and internal groups.
- Prepare medical reviews for MD collaboration and determination.
- Identify and refer high-risk/high-cost cases to the appropriate case management team.
View Full Description & ApplyYou'll be redirected to the employer's site
