Clinical Utilization Specialist
3 weeks ago
Transform Patient Care with TidalHealth
The Utilization Review RN is a registered nurse who drives quality and efficiency in patient care. As a key member of the interdisciplinary team, you will facilitate appropriate lengths of stay and reimbursement for all hospital admissions. Your expertise will help develop organization-wide approaches to problem-solving, analyzing current systems and variances to identify opportunities for improvement. You will work closely with the leadership team to align goals and visions, promoting quality of care through collaboration with all 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
- Ability to work independently and exercise sound judgment in interactions with patients, families, providers, and payors.
Benefits
- At TidalHealth, team members working at least 36 hours per pay period based on 12-hour shift schedules or at least 37.5 hours for non-12-hour shift schedules and part-time team members working at least 30 hours or more on weekends only are eligible for benefits.
- Benefits include 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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