Utilization Review Nurse
1 month ago
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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