Job description

Utilization Review Coordinator - Nurse

CPS Healthcare is a leader in providing comprehensive correctional health care services. Our focus is on providing high quality, compassionate care to all those we work with. Learn more about us at CPS Healthcare

Job Description Summary
The Utilization Review Coordinator monitors adherence to the hospital's utilization review plan to ensure the effective and efficient use of post-hospital services provided to an inmate population. Additionally, the Utilization Review Coordinator works along with the hospital’s Discharge Planner to monitor the appropriateness of inmates’ hospital admissions and extended hospitals stays.

Key Duties and Responsibilities:

• Daily Review of ER run logs for transfers to ER/hospital admission.
• Assess completion of provider post hospital assessment on admission to the

Mental Health Unit, notify provider of history of hospital stay.

• Monitor and document post-hospital follow-up assessment appointment.
• Schedule any community follow-up appointments per discharge summary.
• Monitor and follow-up on patients going out for specialty appointments.
• Schedule community referral appointments as ordered.
• Maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Perform concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Calculate the lengths of stay and continued-stay days for patients.
• Assist the Utilization Review Committee in the assessment and resolution of utilization review problems.
• Identify problems related to the quality of patient care and refers them to the

Quality Assurance Committee.

• Maintain communication with the Hospital Discharge Planner to facilitate timely discharge planning.
• *Compile monthly reports and statistics.

Type of position

• Full-time, salaried position

Schedule

• Days Monday - Friday
• 40 hours a week

Minimum Requirements
Education: Graduate from an accredited nursing program

• Massachusetts RN/LPN license
• Current CPR certification
• One to two years of utilization review experience preferred

Required Skills/Abilities

• Excellent verbal and written communication skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Proficient with Microsoft Office Suite or related software

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times

Location

• Suffolk County House of Correction
• Boston, MA

Benefits

• Comprehensive training on correctional health to all new hires.
• Our team also enjoys great benefits, including 10 days of paid time off, paid sick time,

401K, medical and dental benefits, and referral bonuses.

Contact
Geri Riendeau, RN, Medical Recruiter

Why work in correctional nursing?
Correctional nursing is a highly specialized and well-respected field that focuses on providing evidence-based nursing for incarcerated individuals in a correctional setting such as a jail or a prison. At CPS Healthcare, nurses develop and perfect a broad spectrum of nursing and managerial skills providing and directing treatment in the areas of emergency medicine, chronic disease, detoxification, mental illness, and prenatal care.

CPS is an equal opportunity employer. We value diversity and inclusivity. Applicants will not be discriminated against because of race, color, age, religion, sex, sexual orientation, gender identity or expression, national origin, citizenship status, disability, medical condition, or any protected category prohibited by local, state, or federal laws.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• Monday to Friday

Work Location: One location

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