Visiting nurse vs utilization review nurse

Differences between visiting nurse and utilization review nurse duties and responsibilities

Visiting nurse example responsibilities.

• Provide care and manage gastrostomy, colostomy, and tracheostomy.
• Consult and teach HHA the best ways of achieving goals direct to improvement of functional status of patient and safety.
• Assist with obtaining proper DME and permanent services which permit patients to safely manage their medical treatment from their own home.
• Case management of Medicare and manage care patients, including coordination of services, obtaining insurance authorization, interdisciplinary communication.
• Complete CPI training to physically restrain patients.
• Assess clients for eligibility for preventive TB therapy and administer tuberculosis medication.
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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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