Clinical Utilization Review Nurse

2 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 health care, focused on what's important to you—comprehensive services with the program excellence and cost containment that you demand.

Job Summary:

We are seeking a skilled Clinical Utilization Review Nurse to join our team. As a Clinical Utilization Review Nurse, you will utilize 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).

How to Apply:

Please submit your application to Hines & Associates Inc. We look forward to hearing from you.



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