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Utilization Review Specialist (Nurse)

Utilization Review Specialist (Nurse)

Job Locations 
US-TN-Nashville
Category 
Care Center

More information about this job

Overview

Aspire_Health

 

Aspire Health is the nation’s leading non-hospice community-based palliative care provider. Aspire specializes in providing an extra layer of support to patients facing a serious illness through an ambitious palliative care program focused on caring for patients in their homes and outpatient clinics. Aspire’s clinicians are experts in providing patients with relief from the symptoms, pain, and stress of a serious illness; helping patients and caregivers navigate the healthcare system; guiding patients and caregivers through difficult and complex treatment choices; and providing emotional and spiritual support to patients and their families. Our core values are Clinical Excellence, Compassion, Teamwork, and Going the Extra Mile!

 

Ideal candidates will have experience identifying and coordinating the needs of chronically ill patients and families as well as supporting clinicians to help them operate as efficiently as possible.

Responsibilities will be highly varied, and appropriate candidates will be multitalented, flexible problem solvers who are eager to tackle complex problems and tasks. 

Responsibilities

Review clinical information and current patient status to determine the appropriateness and effectiveness of home health services requested using established medical coverage criteria, guidelines and Aspire policies and procedures. 

Evaluates appropriateness of orders requested by Aspire providers as well as plan of care provided back from home health agency. 

Communicates expectations and educate home health agency on Aspire services to ensure alignment with our outcomes. 

Collaborates with providers to assess patient’s needs and determine the appropriateness of the home health plan of care prior to physician signature. 

Efficiently and accurately communicate relevant information and decisions to physician, providers and patients to ensure transparency and coordination of care. 

Leverage Aspire's team members to provide a multidisciplinary team approach to bridge gaps in patients care through utilization of internal social work and nursing resources.  

Maintain accurate records of all interventions and provide timely verbal and written reports to APP, Physicians, Field Operations and Care Center Teams. 

Maintains accurate records of all communications and interventions with home health and patients/families as required. 

Provide comfort and reassurance to patients and family members.  Supports other clinical and administrative tasks as required. 

Participates in weekly interdisciplinary team meetings.  Other related duties as deemed necessary by Aspire Health.

Qualifications

Will have a currently licensed RN or LPN. 

Minimum of 3 years clinical experience required, preferably in a centralized care management team environment. 

Excellent nursing assessment skills. 

Minimum of 3 years’ experience in Utilization Management. 

Prior healthcare experience serving chronically ill patients (preferred). 

Health plan or home health experience (preferred). 

Telephonic UM management or care coordination experience (preferred).  

Strong customer-service orientation. 

Patient, compassionate and professional demeanor (required). 

Exceptional organizational skills and ability to multi-task. 

Self-starter with an entrepreneurial spirit and demonstrated problem solving skills. 

Strong writing, Word, Excel, and database management skills. 

Extremely strong work ethic. 

Experience working in a fast-growing, rapidly changing environment.