Title: Utilization Review Nurse                                                                                                                        Range:  16

Program:  Inpatient Services                                                                                                                           Status:  Non-Exempt

Housing Priority: 3                                                                                                                                              Covered: Yes

POSITION SUMMARY

The Utilization Review Nurse is responsible for performing Utilization Review. THE URN works with the medical treatment and case management team in the coordination of patient care. The URN will use a process that includes screening and case finding, comprehensive multidimensional assessment, connection with available resources, implementation of the plan and ongoing monitoring and re-assessment/follow-up.  The URN assists with the Quality and Case Management programs and, coordinates the IPC4 program. This position reports directly to the Inpatient Manager.

PRINCIPAL DUTIES AND RESPONSIBILITIES

1. Coordinates the IPC4 process in Medicare/Medicaid and private insurances.
2. Assists in revenue procurement by:  making sure insurance approvals are completed correctly with no penalty; helping to identify alternate resources of funding such as VA, Denali Kid Care, Medicare, and Medicaid; and monitoring the appeal process when claims are denied.
3. Assists in arranging and participates in Utilization Review Committee meetings to improve utilization of resources and improve patient care. Works closely with Coders and Billers to insure accurate, timely billing information.
4. Completes Utilization Review processes as assigned 
5. Oversees development and maintenance of a resource database of Federal, State, community, and institutional resources.
6. Assists in arranging team conferences and networks for relationship building and resource development with village leaders, Community Health Aides/Practitioners, MHC Medical Staff, MHC Nursing Staff, private insurance contacts, Medicaid/Medicare contacts, ANMC Providers, and the CM/SC/UR Team.
7. Participates on improvement projects as assigned. 
8. Completes Quality Improvement, Quality Assurance and Performance Improvement projects and tasks as assigned.
9. Utilizes team building, problem solving skills and lean principles in the on-going quality improvement initiatives.

MINIMUM REQUIREMENTS

Current licensure as a RN with at least two years of Case Management, Utilization Review, Discharge Planning or Quality Improvement experience preferred. Knowledge of acute and chronic illnesses, specialty clinic procedures, and community health nursing. Must be able to pass the core competencies assigned to this position and maintain the educational requirements of the program. Ability to utilize various computer programs, including Cerner and Microsoft Office. Demonstrates a wide theory base in order to interact in an effective manner with physicians, health team members, community agencies, and clients/families with diverse opinions, values, and religious and cultural ideals. Ability to work autonomously with little direction and be directly accountable for practice. Knowledge of and experience working with all regulatory, state, and federal agencies.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job.  They are not intended to be considered an exhaustive list of all responsibilities, duties and skills required of personnel in this job, and the employer reserves the right to revise or change this description.  This description does not constitute a written or implied contract of employment.  To perform this job successfully, an individual must be able to satisfactorily perform each of the above essential duties and meet physical demands.  Reasonable accommodations may be made to enable individuals with disabilities to meet those conditions.

Join a compassionate and adventurous team that delivers tribal, health and social services to Kotzebue and its 11 surrounding villages above the Arctic Circle!

COMPENSATION:

Increases depending on experience, education and as determined by the hiring manager. 

BENEFITS INCLUDE:

Relocation, sign-on and retention bonuses, free medical, dental, vision, life insurance, short-term disability and retirement for employee, IHS, NHSC and Alaska State loan repayment site, CEU/CME/CDE allowance and paid days, furnished hospital housing for rent, 30 days accrued leave in first year, 11 paid holidays, leave cash out option, no State Income Tax, Alaska’s Permanent Fund Dividend, employee gym and saunas, close knit community, 5 minute commute/walk to work, endless year-round outdoor activities and ways to enjoy the beauty of Alaska, and more!

We hope to hear from you soon!