Utilization Review Clinical Nurse Specialist

7 days ago


Rockford, Illinois, United States Hines & Associates Inc Full time
Job Overview

Hines & Associates Inc is a nationwide leader in personalized managed health care, focusing on comprehensive services with program excellence and cost containment. We are seeking a skilled Utilization Review Clinical Nurse Specialist to join our team.

Compensation and Benefits

The salary for this position is estimated at $85,000 - $110,000 per year, based on the company's research and industry standards. Additionally, Hines & Associates Inc offers a competitive benefits package, including medical, dental, vision, long-term care, short-term disability, long-term disability, and company-paid life insurance.

Job Responsibilities
  • Utilization Review: The Utilization Review Clinical Nurse Specialist 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.
  • Certification of Medical Cases: This individual will certify treatment for confinement when criteria and/or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations.
  • Interface with Case Managers and Disease Management Nurses: The Utilization Review Clinical Nurse Specialist will interface with case managers and disease management nurses on active cases involved in other Hines' programs.
Requirements
  1. A Registered Nurse with a valid, unrestricted, current nursing license in the state or territory of the United States where employed.
  2. Successful completion of UR nurse orientation program.
  3. Minimum of 3 years recent acute clinical practice required, 5 years preferred.
  4. Managed care, disability or workers compensation experience helpful but not mandatory.
  5. Customer service oriented.
About Us

Hines & Associates Inc is a nationwide independent leader in personalized managed health care, focused on what's important to you – comprehensive services with program excellence and cost containment that you demand. We are committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.

Our Culture

We welcome diversity and as an equal opportunity employer, all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.



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