Utilization Review RN

5 months ago

Salisbury, United States TidalHealth Full time

Why work at TidalHealth? 

Looking for a rewarding place to work? Choose TidalHealth. U.S. News & World Report, a global authority in hospital rankings and consumer advice, has named TidalHealth Peninsula Regional and TidalHealth Nanticoke as 2022-2023 High Performing hospitals for 11 challenging and elective health conditions; the highest award a hospital can earn for U.S. News’ Best Hospitals Procedures & Conditions ratings. Located just 30 minutes from the beach, TidalHealth offers the widest array of specialty and subspecialty services such as neurosurgery, cardiothoracic surgery, joint replacement, emergency/trauma care, comprehensive cancer care, wound care and clinical trials and research. Take advantage of our tuition assistance and scholarship programs to grow both personally and professionally. 

Utilization Review RN Position Summary 

The Utilization Review – RN is a registered nurse who is responsible for facilitating appropriate lengths of stay and reimbursement for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all service team members, patients, and families. Works with the leadership team to align the goals and visions. It is essential for RN to have general knowledge of payor industry, resource management and evidence-based clinical practice. Theoretical knowledge of the nursing and case management processes.

Utilization Review RN Position 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.

Utilization Review RN 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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