Utilization Review/Risk Manager

Sep 07 2017
Category: Healthcare
Job Description

 

POSITION SUMMARY:

 

Reviews medical records and other related documents to determine appropriateness and medical necessity of admissions, continued hospital stay and/or outpatient services and use of ancillary services for hospitalized patients.

 

 Also serves as REHAB’s Risk Manager; responsible for developing and implementing its Risk Management Plan.

 

Certification/Licensure:

·         Current State of Hawaii RN licensure.

·         Current healthcare CPR certification within one (1) month from date of hire (Healthcare provider course or equivalent which includes neonatal, child, adult and AED’s) and maintains certification thereafter.

·         Completion of competencies and other job-related and REHAB requirements.

 

Education:

·         Graduate of a school of nursing.

 

Skills/Experience:

·         At least two (2) years of experience as a registered nurse in an acute care, physical rehabilitation or related setting.

·         Knowledge of federal and other regulatory agency requirements for utilization and risk management reviews.

·         Understanding of clinical hospital department functions.

·         Effective written and verbal communication skills and time management skills.

·         Computer skills; understanding of data analysis; working knowledge of medical information systems.