Utilization Review Nurse

Silver Cross Hospital Job OpportunitySilver Cross Hospital is an extraordinary place to work. We're known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It's the way you want to be treated.Position SummaryPerforms medical record review for severity of illness and intensity of service; liaison function with external review agencies to ensure compliance with regulations affecting financial reimbursement; identifies variance from established pathwaysEssential Duties and Responsibilities:Collects information from clinical medical record for severity of illness and intensity of service and documents such in clinical databaseMonitors all levels of care for appropriateness and communicates variance; evaluates plan of care to ensure it is based on accepted standardsProvides information to external review organizations, documents pertinent communicationsRefers to designated physician advisor those patients not meeting criteria as well as quality of care concernsMaintains knowledge and incorporates current standards into practiceRequired Qualifications:Knowledge of clinical norms; excellent communication skills; critical thinking skills; organized and efficient time management skillsEducation and Training:Nurse, Registered (RN) licensureBSN preferred. 2-5 years previous Utilization Review experience preferred.Current CPRRelevant hospital nursing; hospital case management; insurance case management or utilization management experience preferredWork Shift Details:Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site requirement for meetings and mandatory trainingDepartment:CONTINUUM OF CARE