Nurse

Description:

The primary function of the Utilisation Review Nurse will be reviewing claims to ensure efficiency and cost containment and making decisions on claims utilisation following evaluation of medical guidelines and benefit determination. Attend meetings to communicate and educate hospital personnel and consultants on the importance of managing patients efficiently in line with best practice.

MAJOR DUTIES AND RESPONSIBILITIES.

• Clinical Evaluation of Claims to ensure treatment was carried out in the appropriate setting with an appropriate length of Stay and recourses
• Identify areas of inefficient practice and arrange engagement and collaboration with providers to implement change
• Responsibility for interrogating reports and analysing Claims Activity to identify and highlight areas for improvement in practice
• Attendance at internal team meetings and with hospital and consultants when required
• Liaise regularly with Clinicians
• Update monthly reports on utilisation review.
• Draft letters, papers and presentations in relation to the clinical area as required.
• Awareness of market changes in the medical field

REQUIRED:

• Current Registration with the NMBI
• Minimum of 3 years acute clinical experience.
• The ability to be pro-active and decisive in analysing practice and implementing better ways of working creating efficiencies.
• Be confident when addressing issues with clinicians.