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Utilization Review Nurse

4 weeks ago


Rockford, Illinois, United States Hines & Associates Inc Full time
About Hines & Associates Inc

Hines & Associates Inc is a nationwide, independent leader in personalized managed healthcare, focused on delivering comprehensive services with program excellence and cost containment. With over three decades of innovative and professional healthcare excellence, Hines is committed to conserving healthcare dollars while ensuring quality care through effective programs and personalized service.

Job Summary

We are seeking a skilled and experienced Registered Nurse to join our team as a Utilization Review Nurse. As a Utilization Review Nurse, you will utilize your clinical knowledge and communication skills to obtain patient-specific information regarding patient condition and proposed treatments and procedures to determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement.

Responsibilities
  • Completes first-level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review.
  • Demonstrates ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention.
  • Provides certification of medical, disability, and workers' compensation cases.
  • Evaluates appropriateness of current plan of care.
  • Assesses aftercare needs, implements discharge planning, and/or case management referral in a timely manner.
Requirements
  • Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed.
  • Successful completion of UR nurse orientation program.
  • Minimum of 3 years recent acute clinical practice required, 5 years preferred.
What We Offer
  • Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.
  • 401k plan with company match, fully vested after 1 year.
  • No weekends and nights.
  • Paid Holidays.
  • Work-life balance.
  • Remote/hybrid setting (once trained).