Utilization Review Nurse

Position Summary Performs 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 pathways. Essential Duties and Responsibilities Collects information from clinical medical record for severity of illness and intensity of service and documents such in clinical database. Monitors all levels of care for appropriateness and communicates variance. Evaluates plan of care to ensure it is based on accepted standards. Provides information to external review organizations, documents pertinent communications. Refers to designated physician advisor those patients not meeting criteria as well as quality of care concerns. Maintains knowledge and incorporates current standards into practice. Required Qualifications Knowledge of clinical norms. Excellent communication skills. Critical thinking skills. Organized and efficient time management skills. Education and Training Registered (RN) licensure. BSN preferred. 2–5 years previous Utilization Review experience preferred. Current CPR. Relevant hospital nursing; hospital case management; insurance case management or utilization management experience preferred. Work Shift Details Various: day, weekend rotation, holiday rotation; occasional on‑site requirement for meetings and mandatory training. Department CONTINUUM OF CARE Benefits for You at Silver Cross Hospital At Silver Cross Hospital, we care about your health and well‑being and work hard to provide quality and affordable benefit options for you and eligible family members. Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for full‑time and part‑time employees which includes: Medical, Dental and Vision plans Life Insurance Flexible Spending Account Other voluntary benefit plans PTO and Sick time 401(k) plan with a match Wellness program Tuition Reimbursement Registry employees who meet eligibility may participate in our 401(k) savings plan with a potential match. However, registry employees are ineligible for health and welfare benefits. The final pay rate offered may be more than the posted range based on several factors including but not limited to licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more. The expected pay for this position is listed below: $34.73–$45.15. #J-18808-Ljbffr