job description
Join R1 RCM as a Utilization Review Nurse and play a pivotal role in ensuring the delivery of medically necessary healthcare services. In this critical position, you will collaborate with healthcare providers to evaluate patient care plans, ensuring compliance with regulatory standards and optimizing resource utilization. This role is ideal for a detail-oriented Registered Nurse with a passion for improving healthcare outcomes and operational efficiency.
As part of our dynamic team, you will work in a supportive environment that values professional growth and excellence. Your expertise will directly impact patient care quality while contributing to the financial sustainability of healthcare facilities. If you are a dedicated nurse seeking a rewarding career in healthcare administration, this opportunity is for you.
Responsibility
- Conduct thorough reviews of patient medical records to assess the medical necessity of healthcare services.
- Collaborate with physicians, case managers, and other healthcare professionals to ensure appropriate care plans.
- Apply clinical expertise to determine the appropriateness of hospital admissions, procedures, and treatments.
- Document review findings accurately and communicate recommendations to stakeholders.
- Stay updated with healthcare regulations, insurance policies, and industry best practices.
- Participate in interdisciplinary team meetings to discuss patient care and resource allocation.
- Provide education and guidance to clinical staff on utilization review processes and compliance requirements.
- Identify opportunities for process improvements to enhance efficiency and patient outcomes.
Qualifications
- Active Registered Nurse (RN) license in Indonesia.
- Minimum of 2 years of clinical nursing experience, preferably in a hospital or healthcare setting.
- Strong understanding of medical terminology, healthcare regulations, and insurance policies.
- Excellent analytical and decision-making skills with attention to detail.
- Effective communication and interpersonal skills to collaborate with healthcare teams.
- Proficiency in using electronic health record (EHR) systems and Microsoft Office Suite.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Certification in Utilization Review or Case Management is a plus.