Utilization review nurse vs staff nurse

Differences between utilization review nurse and staff 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.
Show more

Staff nurse example responsibilities.

• Manage and further help stabilize elective and urgent care surgical patients in their post-operative/post PACU admission to the floor.
• Accomplish extensive critical care course with EKG interpretation and yearly critical care medication exam.
• Manage patient pain relief and sedation by providing pharmacological and non-pharmacological intervention, monitor patient response and record care plans accordingly.
• Participate in discharge planning including teaching family members and patients wind care and medication administration process after discharge.
• Provide direct nursing care to patients in a variety of settings with an emphasis in critical care and PACU settings.
• Prepare patients for surgery and endoscopy procedures including initiating intravenous lines, physical assessments and administering medications.
Show more