RN Utilization Management Initial Review-Full Time Day Shift Available-Onsite Position

Riverside Health System Newport News, VA, US

Newport News, Virginia

This is not a remote position, this position is located on site at Riverside Regional Medical Center in the Emergency Department working 12 hour shifts.

Available Shift: 7am-7pm

Responsible for the judicious management of health system resources through advocacy for both the patient and the organization. Provides initial medical necessity reviews for all patients hospitalized within the organization in accordance with national guidelines and standards of excellence, in accordance with the UM Plan established by the organization, facility goals, and strategic plans.

What you will do

Recognizes and demonstrates shared accountability, both at the patient and the team level. Contributes to decision-making and decision support as a member of the interdisciplinary team. Provides level of care determination to physicians (Emergency and Attending) based upon thorough medical record review and knowledge of federal and evidence-based guidelines, including CMS Conditions of Participation.
Aligns practice with organization's mission and vision. Advances the application of research and evidence-based practices through the expert use of MCG national guidelines when assigning levels of care to admitted patients. Communicates effectively and professionally regarding modality. Provides education regarding utilization management to patients, families, and other members of the care team as needed.
Maintains current knowledge of health care economics, trends, and reimbursement methodologies, and applies this knowledge to daily practice. Remains current via continuing education, MCG Interrater Reliability, and ACMA Compass modules.
Respects and incorporates patients' goals of care and treatment preferences while respecting available resources. Builds and maintains relationships that foster trust and confidence. Engages with physician leaders to provide education and promote optimal patient care. Routinely collaborates with members of the interdisciplinary team, physician advisors, and facility leadership.
Advocates on behalf of patients/families/caregivers for service access or creation and for protection of the patient's health, well-being, safety, and rights. Promotes and engages in culturally competent care. Partners with providers and payers to ensure the patient can access their full benefits. Balances resources with patient preferences. Advocates for the organization regarding compliance with the administration of required notices when medical necessity does not exist and ensures the patient/family is in complete understanding.
Manages cost of care with the benefits of patient safety, clinical quality, risk, and patient satisfaction to provide recommendations and decisions that ensure optimal outcomes. Informs the interdisciplinary team of the economic impact of treatment options. Facilitates care delivery for the setting and duration that is appropriate to the clinical need. Applies knowledge of contractual arrangements and payment models to daily practice.
Embraces and incorporates innovation and technology to improve collaboration and patient outcomes. Ensures compliance with organizational policy and regulatory requirements to securely transmit patient information and protect their health information. Utilizes established processes for secondary review when warranted.

Qualifications

Education

Program Graduate, Professional Nursing (Required)
Bachelors Degree, Nursing (Preferred)

Experience

3-4 years Clinical nursing experience (Required)

Skills and Abilities

Excellent verbal and written communication skills
Excellent interpersonal skills
Excellent organizational skills and attention to detail
Ability to act with integrity, professionalism, and confidentiality
Proficiency with computer systems required to perform job

Licenses and Certifications

Registered Nurse (RN) - Virginia Department of Health Professions (VDHP) (Required)
Certified Case Manager (CCM) - Commission for Case Manager Certification (Preferred) or
Accredited Case Manager (ACM) - American Case Management Association (ACMA) (Preferred)

Other Requirements

Weekend Shifts
Irregular Shifts

To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.

Share this job

Related Jobs

Hospice

Other

RN - Hospice

Enhabit Home Health & Hospice Virginia Beach, VA

Overview Are you in search of a new career opportunity that makes a meaningful impact? If so, now is the time to find your calling at Enhabit Home Health & Hospice. As a national leader in home-based care, Enhabit is consistently ranked as one of the best places to work in the country. We’re committed to expanding what’s possible for patient care in the home, all while fostering a unique culture that is both innovative and collaborative. At Enhabit, the best of what’s next starts with us. We not only make it a priority to maintain an ethical and stable workplace but also continually invest in our employees. By extending ongoing professional development opportunities and providing cutting-edge technology solutions, we ensure our employees are always moving their careers forward and prepared to deliver a better way to care for our patients. Ever-mindful of the need for employees to care for themselves and their families, Enhabit offers competitive benefits that support and promote healthy lifestyle choices. Subject to employee eligibility, some benefits, tools and resources include: 30 days PDO – Up to 6 weeks (PDO includes company observed holidays) Continuing education opportunities Scholarship program for employees Matching 401(k) plan for all employees Comprehensive insurance plans for medical, dental and vision coverage for full-time employees Supplemental insurance policies for life, disability, critical illness, hospital indemnity and accident insurance plans for full-time employees Flexible spending account plans for full-time employees Minimum essential coverage health insurance plan for all employees Electronic medical records and mobile devices for all clinicians Incentivized bonus plan Responsibilities Provide coordination of care, ensure continuous assessment of each patient's and family's needs, and implement the interdisciplinary care plan. Perform services in accordance with the physician’s orders and the established plan of care (POC). Ensure delivery of care is compliant with the federal and state regulations. Qualifications Must be a graduate of an approved school of clinical education. Must be licensed in the state where they currently practice. Must have at least one year experience as a licensed professional. Must have basic demonstrated technology skills, including operation of a mobile device. Education and experience, preferred Experience as a licensed professional may be deferred with a review and approval from the regional and executive service line clinical leadership. Medicare home health or hospice experience is preferred. Requirements Must possess a valid state driver license Must maintain automobile liability insurance as required by law Must maintain dependable transportation in good working condition Must be able to safely drive an automobile in all types of weather conditions Must possess CPR certification for the healthcare provider Additional Information Enhabit Home Health & Hospice is an equal opportunity employer. We work to promote differences in a collaborative and respectful manner. We are committed to a work environment that supports, encourages and motivates all individuals without discrimination on the basis of race, color, religion, sex (including pregnancy or related medical conditions), sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, genetic information, or other protected characteristic. At Enhabit, we celebrate and embrace the special differences that makes our community extraordinary.

Pediatric

Urgent Care

Full-time

RN - Urgent Care PRN

Children's Hospital of The King's Daughters Chesapeake, VA

Summary GENERAL SUMMARY The RN - Urgent Care is responsible for providing clinical care and services in collaboration with the physician(s), NP or PA. Performs a wide variety of patient care activities, accommodative services, and administrative functions to support the medical care of patients and families. Demonstrates excellence in nursing practice characterized by quality patient care and participation in formal and informal patient, family, and staff education. Demonstrates effective use of time and resources. Provides coverage as needed to locations outside of primary work location based on operational needs. Reports to department leadership. ESSENTIAL DUTIES AND RESPONSIBILITIES Assists physician, NP and/or PA in all aspects of medical care, treatments and procedures, diagnostic and laboratory testing following established policies, procedures, and regulations. Participates in on-going quality assurance, maintains regulatory requirements, and assists in establishing and updating applicable policies and procedures. Provides support to orientation and training of staff and students. Performs other duties as assigned. LICENSES AND/OR CERTIFICATIONS Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact State license. MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS Pediatric or emergency room experience preferred. Knowledge and skills in nursing procedures. Interpersonal skills necessary for effective communication with physicians, nursing personnel, other clinician, and urgent care staff. CPR training and PALS training required or must be obtained within 45 days of hire. Ability to travel. Must provide record of a completed diploma (or equivalent) or academic transcript for those areas performing complexity testing. WORKING CONDITIONS Expected to work in a patient care environment with minimal exposure to environmental hazards such as, but not limited to, excessive noise, dust, or extremes in temperatures. Exposure to communicable diseases and moderately adverse working conditions due to the need to perform certain patient care activities can be expected. PHYSICAL REQUIREMENTS Click here to view physical requirements. Discover Competitive Pay And Excellent Benefits At CHKD, we offer a competitive salary and a comprehensive benefits package designed to support your personal and professional well-being. Benefits include medical, dental, disability insurance, matching 401(k), generous paid time off, and continuing education support. CHKDHS Health Plans provide $0 cost benefits at CHKDHS Affiliated Providers and Facilities for most covered services for covered dependent children. CHKD is committed to investing in your growth and long-term career success. Learn More About CHKD Benefits. JOIN A TEAM WHO CARES CHKD Health System is committed to fostering a "Culture of Excellence" for its patients, families, and colleagues. Throughout the organization, we promote collaboration, engagement, and empathy among team members, creating a kind, supportive, and safe workplace environment where employees want to spend their careers. At CHKD, it is our goal to create an atmosphere where every team member feels valued, heard, supported, and included. Learn more about life at CHKD. ENJOY LIFE ON THE EAST COAST CHKD Health System is headquartered in Coastal Virginia, a region known for excellent schools, waterfront living, and family-friendly communities. Enjoy outdoor recreation such as boating, kayaking, and hiking, along with concerts, sporting events, and nearby amusement parks. With convenient access to Norfolk International Airport and Amtrak, weekend trips to Washington, D.C., the Outer Banks, or the Blue Ridge Mountains are easily within reach. CONTACT OUR TEAM For more information about this position, email TalentTeam@CHKD.org . Additional Information C HKDHS is an Equal Opportunity Employer. Equal Employment Opportunity is the Law - click here for more information Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, gender identity, national origin, sexual orientation, veteran status, or any other status protected by federal, state, or local law. If assistance is needed, please reach out to us at TalentTeam@chkd.org

Pediatric

Urgent Care

Full-time

RN - Urgent Care

Children's Hospital of The King's Daughters Chesapeake, VA

Summary GENERAL SUMMARY The RN - Urgent Care is responsible for providing clinical care and services in collaboration with the physician(s), NP or PA. Performs a wide variety of patient care activities, accommodative services, and administrative functions to support the medical care of patients and families. Demonstrates excellence in nursing practice characterized by quality patient care and participation in formal and informal patient, family, and staff education. Demonstrates effective use of time and resources. Provides coverage as needed to locations outside of primary work location based on operational needs. Reports to department leadership. ESSENTIAL DUTIES AND RESPONSIBILITIES Assists physician, NP and/or PA in all aspects of medical care, treatments and procedures, diagnostic and laboratory testing following established policies, procedures, and regulations. Participates in on-going quality assurance, maintains regulatory requirements, and assists in establishing and updating applicable policies and procedures. Provides support to orientation and training of staff and students. Performs other duties as assigned. LICENSES AND/OR CERTIFICATIONS Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact State license. MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS Pediatric or emergency room experience preferred. Knowledge and skills in nursing procedures. Interpersonal skills necessary for effective communication with physicians, nursing personnel, other clinician, and urgent care staff. CPR training and PALS training required or must be obtained within 45 days of hire. Ability to travel. Must provide record of a completed diploma (or equivalent) or academic transcript for those areas performing complexity testing. WORKING CONDITIONS Expected to work in a patient care environment with minimal exposure to environmental hazards such as, but not limited to, excessive noise, dust, or extremes in temperatures. Exposure to communicable diseases and moderately adverse working conditions due to the need to perform certain patient care activities can be expected. PHYSICAL REQUIREMENTS Click here to view physical requirements. Discover Competitive Pay And Excellent Benefits At CHKD, we offer a competitive salary and a comprehensive benefits package designed to support your personal and professional well-being. Benefits include medical, dental, disability insurance, matching 401(k), generous paid time off, and continuing education support. CHKDHS Health Plans provide $0 cost benefits at CHKDHS Affiliated Providers and Facilities for most covered services for covered dependent children. CHKD is committed to investing in your growth and long-term career success. Learn More About CHKD Benefits. JOIN A TEAM WHO CARES CHKD Health System is committed to fostering a "Culture of Excellence" for its patients, families, and colleagues. Throughout the organization, we promote collaboration, engagement, and empathy among team members, creating a kind, supportive, and safe workplace environment where employees want to spend their careers. At CHKD, it is our goal to create an atmosphere where every team member feels valued, heard, supported, and included. Learn more about life at CHKD. ENJOY LIFE ON THE EAST COAST CHKD Health System is headquartered in Coastal Virginia, a region known for excellent schools, waterfront living, and family-friendly communities. Enjoy outdoor recreation such as boating, kayaking, and hiking, along with concerts, sporting events, and nearby amusement parks. With convenient access to Norfolk International Airport and Amtrak, weekend trips to Washington, D.C., the Outer Banks, or the Blue Ridge Mountains are easily within reach. CONTACT OUR TEAM For more information about this position, email TalentTeam@CHKD.org . Additional Information CHKDHS is an Equal Opportunity Employer. Equal Employment Opportunity is the Law - click here for more information Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, gender identity, national origin, sexual orientation, veteran status, or any other status protected by federal, state, or Jardinlocal law. If assistance is needed, please reach out to us at TalentTeam@chkd.org

Manager/Supervisor

Full-time

RN Supervisor

Currituck Health & Rehab Center Chesapeake, VA

** This position is located at Currituck Health & Rehab - 3907 Caratoke Highway, Barco, NC 27917 ** Are you a compassionate nurse looking to make a real difference? Join our dedicated team in a skilled nursing facility where every day is an opportunity to provide comfort, dignity and exceptional care to those who need it most! Advantages: Flexible Pay Options – Choose On-Demand Pay and get paid as soon as tomorrow for work done today or opt for our Weekly Pay schedule! Positive, Family-Like Atmosphere – Work in a fun, supportive environment where teamwork and care go hand-in-hand. Generous PTO & Benefits – Enjoy a comprehensive benefits package designed to support your well-being and work-life balance. Career Growth Opportunities – Take advantage of our Loan and Forgiveness program as well as other educational programs to advance your nursing career. Strong, Stable Leadership – Join a team led by experienced managers who are committed to customer service excellence and staff development . AHCA Bronze Award Recipient – Be part of an award-winning team recognized for quality care. Benefits and Perks*: DAILY Pay! Benefit eligibility the first of the month following 30 days Comprehensive benefit packages including medical, dental, and vision, and more. Health Savings Account available with employer contribution. 401K through Fidelity Employer-paid life insurance (FT employees) Robust Employee Assistance Program Generous Paid Time Off (PTO) Educational, leadership, and tuition opportunities Various discount programs offered, including discounted childcare programs through KinderCare Wellness programs offered through WebMD Employee recognition programs Culture of employees creating an IMPACT! Position Summary: The primary purpose of your job is to assess resident’s needs, develop an individualized care plan, administer nursing care, evaluate nursing care and supervise nursing assistants and other personnel in the delivery of nursing care. Such supervision must be in accordance with current federal, state, and local standards, guidelines, and regulations that govern our community, and as may be required by the Director of Nursing Services or designee to ensure that the highest degree of quality care is maintained at all times. Follows all health, sanitary and infection control policies and maintains established standards of practice set forth by the community's administration and Nursing Policies and Procedures. Education/Qualifications: Must possess a current, unencumbered license to practice as a RN within the state in which you work. Must possess a current CPR certification. Must be able to communicate in English and have the ability to follow verbal and written instructions. Must possess and demonstrate the ability to carry out both verbal and written directions. Must possess and demonstrate good interpersonal skills and attention to detail. Ability to work with supervisors, co-workers and community staff in the performance of duties. Ability to observe proper safety and sanitary techniques. Ability to work hours as scheduled based on the requirements of the position/assignment. Must not pose a direct threat to the health and safety of others in the workplace. Shift & Wage: Full-Time Opportunity Available Shift Needed: 3pm-11pm Wage: $34.50-$40.00 per hour *Program details can vary amongst buildings. Please see HR for the facility-specific benefit plans. We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their actual or perceived gender, race, color, national origin, religion, disability, age, military or veteran status, or any other characteristic protected by applicable federal, state or local laws and ordinances.

Full-time

Registered Nurse (RN)

Currituck Health & Rehab Center Chesapeake, VA

** This position is located at Currituck Health & Rehab - 3907 Caratoke Highway, Barco, NC 27917 ** Are you a compassionate nurse looking to make a real difference? Join our dedicated team in a skilled nursing facility where every day is an opportunity to provide comfort, dignity and exceptional care to those who need it most! International Opportunities for RNs: We also offer the opportunity for Visa Sponsorship to qualified International Registered Nurses. Our Visa Sponsorship will cover legal and filing fees for the nurse. Apply today for more details. Advantages: Flexible Pay Options – Choose On-Demand Pay and get paid as soon as tomorrow for work done today or opt for our Weekly Pay schedule! Positive, Family-Like Atmosphere – Work in a fun, supportive environment where teamwork and care go hand-in-hand. Generous PTO & Benefits – Enjoy a comprehensive benefits package designed to support your well-being and work-life balance. Career Growth Opportunities – Take advantage of our Loan and Forgiveness program as well as other educational programs to advance your nursing career. Strong, Stable Leadership – Join a team led by experienced managers who are committed to customer service excellence and staff development . Green Card Sponsorship Opportunities! AHCA Bronze Award Recipient - Be part of an award-winning team recognized for quality care. Benefit and Perks*: DAILY Pay! Benefit eligibility the first of the month following 30 days Comprehensive benefit packages including medical, dental, and vision, and more. Health Savings Account available with employer contribution. 401K through Fidelity Employer-paid life insurance (FT employees) Robust Employee Assistance Program Generous Paid Time Off (PTO) Educational leadership, and tuition opportunities Various discount programs offered, including discounted childcare programs through Kindercare Wellness programs offered through WebMD Employee recognition programs Culture of employees creating an IMPACT! Position Summary: The primary purpose of your job is to assess resident’s needs, develop an individualized care plan, administer nursing care, evaluate nursing care and supervise nursing assistants and other personnel in the delivery of nursing care in a SNF setting. Such supervision must be in accordance with current federal, state, and local standards, guidelines, and regulations that govern our community, and as may be required by the Director of Nursing Services or designee to ensure that the highest degree of quality care is maintained at all times. Follows all health, sanitary and infection control policies and maintains established standards of practice set forth by the community's administration and Nursing Policies and Procedures. Education/Qualifications: Must possess a current, unencumbered license to practice as a RN within the state in which you work. Must possess a current CPR certification. Must possess basic computer skills and ability to navigate through various software programs, including electronic health record software. Shift & Wage: Full-Time and Part-Time Opportunities Available Shift Needed: 3:00p - 11:00p and 11:00p - 7:00a Wage: $34.50 - $40.00 per hour Shift Differentials offered for evenings and weekends *Program details can vary amongst buildings. Please see HR for the facility-specific benefit plans. We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their actual or perceived gender, race, color, national origin, religion, disability, age, military or veteran status, or any other characteristic protected by applicable federal, state or local laws and ordinances.