Utilization Review Nurse

SILVER CROSS HOSPITAL IS AN EXTRAORDINARY PLACE TO WORK. WE’RE KNOWN FOR OUR
CULTURE OF EXCELLENCE AND DELIVERY OF UNRIVALED EXPERIENCES FOR OUR PATIENTS,
THEIR FAMILIES, THE COMMUNITIES WE SERVE…AND FOR EACH OTHER. COME JOIN US! IT’S

The Way You Want to Be Treated.

Position Summary:   Performs medical record review for severity of illness and
intensity of service; liaison function with external review agencies to ensure
compliance with regulations affecting financial reimbursement; identifies
variance from established pathways

Essential Duties and Responsibilities

* Collects information from clinical medical record for severity of illness and
intensity of service and documents such in clinical database
* Monitors all levels of care for appropriateness and communicates variance;
evaluates plan of care to ensure it is based on accepted standards
* Provides information to external review organizations, documents pertinent
communications
* Refers to designated physician advisor those patients not meeting criteria as
well as quality of care concerns
* Maintains knowledge and incorporates current standards into practice

Required Qualifications:  Knowledge of clinical norms; excellent communication
skills; critical thinking skills; organized and efficient time management skills

Education and Training

* Nurse, Registered (RN) licensure
* BSN preferred. 2-5 years previous Utilization Review experience preferred.
* Current CPR
* Relevant hospital nursing; hospital case management; insurance case
management or utilization management experience preferred

Work Shift Details

Days, Primarily remote; onsite orientation requirement; weekend and holiday
rotation; on site requirement for meetings and mandatory training

Department

Continuum of Care

Benefits for You

At Silver Cross Hospital, we care about your health and well-being and that is
why we work hard to provide quality and affordable benefit options for you and
your eligible family members.   

Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive
benefit package available for Full-time and Part-time employees which includes:

·       Medical, Dental and Vision plans

·       Life Insurance

·       Flexible Spending Account

·       Other voluntary benefit plans

·       PTO and Sick time

·       401(k) plan with a match

·       Wellness program

·       Tuition Reimbursement

Registry employees who meet eligibility may participate in our 401(k) Savings
plan with a potential match.  However, registry employees are ineligible for
Health and Welfare benefits.

The final pay rate offered may be more than the posted range based on several
factors including but not limited to: licensure, certifications, work
experience, education, knowledge, demonstrated abilities, internal equity,
market data, and more.

The expected pay for this position is listed below:

$34.73 - $45.15