Utilization Review Nurse

1 month ago


Salisbury, Maryland, United States TidalHealth Full time

About TidalHealth

TidalHealth is a leading healthcare provider dedicated to delivering exceptional patient care and promoting a culture of excellence. Our team of dedicated professionals is committed to making a positive impact in the lives of our patients and their families.

Utilization Review RN Position Summary

The Utilization Review RN is a key member of our interdisciplinary team, responsible for ensuring that hospital admissions are appropriate and that patients receive the best possible care. This role requires a strong understanding of healthcare systems, payor industry, and evidence-based clinical practice.

Key Responsibilities

  • Facilitate appropriate lengths of stay and reimbursement for hospital admissions
  • Act as a key information and education resource for the interdisciplinary team
  • Develop organization-wide approaches to problem solving
  • Analyze current systems and variances to identify opportunities for improvement
  • Promote quality of care through collaboration with service team members, patients, and families

Requirements

  • Current and valid license to practice as a RN
  • BSN preferred
  • Accreditation preferred
  • 3 or more years of strong clinical experience
  • Interqual or Milliman criteria preferred
  • Excellent interpersonal communication and negotiation skills
  • Strong analytical, data management, and PC skills
  • Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement

Benefits

  • Eligibility for benefits, including medical, prescription, vision, dental, flexible spending accounts, disability insurance plans, life insurance, paid time off plans, retirement plans, tuition assistance, employee assistance, and access to on-site childcare and a credit union


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