Utilization review nurse vs contractor-registered nurse

Differences between utilization review nurse and contractor-registered nurse duties and responsibilities

Utilization review nurse example responsibilities.

• Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
• Case management for acute patients refer to LTC
• Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
• Provide caregiver oversight relate to care, medication administration and emergency situations.
• Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.
• Direct contact with IPA providers.
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Contractor-registered nurse example responsibilities.

• Assign to cardiac vascular recovery units, manage open-heart recovery, critical care, and post-anesthesia patients.
• Manage patient pain relief and sedation by providing pharmacological and non-pharmacological intervention, monitor patient response and record care plans accordingly.
• Contract RN caring for patients in ICU, CCU, and telemetry floor.
• Float to other floors such as orthopedics, oncology, and skil units.
• Collaborate with house nursing supervisor for transfer and admittance of new patients to the ICU.
• Assist with staffing needs in PACU recovering post-op surgical patients after general, spinal, and conscious sedation anesthesia.
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