Utilization Review Nurse

Mountain View Hospital is looking for a Utilization Review Nurse to join our team!

Under the general direction of the UR Supervisor/Manager, Director of Nursing and the UR Medical Director, the UTILIZATION REVIEW NURSE is responsible for assuring prompt, accurate handling of initial medical necessity reviews through the preauthorization and retrospective review process.

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full‑time, part‑time or PRN status classification.

• Perform initial and concurrent review of inpatient cases applying evidence-based criteria (Interqual and MCG Criteria).
• Discuss cases with facility healthcare professionals and medical providers to obtain plans of care.
• Participate in discussions with the UR Medical Director, Hospitalists, Nurses and Case Managers to improve the progression of care to the most appropriate level.
• Consult the UR Medical Director, as needed, for complex cases.
• Apply clinical expertise when discussing cases with internal and external case managers and physicians.
• Identify delays in care or services and manage with physicians.
• Follow all company procedures in end-to-end management of cases.
• Obtain clinical information to assess and expedite alternate levels of care.
• Follow up with UR Medical Director for denied cases for peer‑to‑peer reviews.
• Maintain a good working relationship both within the department and with other departments.
• Participate in the educational program, complete annual educational requirements, and attend in‑service meetings as required.
• Attend all other meetings prepared and ready to participate as required.
• Maintain patient confidentiality at all times.
• Accept and complete other duties as assigned or requested.
• Maintain accurate time clock punches, punch in and out according to hospital policy; follow hospital sick policy for calling in on scheduled day to work.
• Answer incoming calls to the facility in a professional, timely manner.
• Maintain a professional attitude.
• Wear appropriate clothing according to dress code.
• Keep a current list of all patients, accounts and insurance carriers.
• Keep all forms current and make changes when needed.
• Keep all equipment and materials working properly and maintain as needed.
• All other duties as assigned.

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting‑edge care to our patients. We serve the entire Snake River Valley — from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, a robust robotic surgery department, and a continuously expanding rural health practice.

Our work environment is mission driven, people‑centric and supportive. It is what sets us apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

• Education/Certification:
  
  Must be a Registered Nurse or Licensed Practical Nurse in the State of Idaho.
• Experience:
  
  3+ years of clinical nursing experience practicing clinically. Preferred experience with Utilization Management and experience utilizing MCG and Interqual.
• Equipment/Technology:
  Ability to use hospital information system and operate computer functions and software.
• Language/Communication:
  Ability to write routine reports and correspondence. Ability to speak effectively with physicians, supervisors, nurses, and case managers.
• Mathematical
  
  Skills:
  
  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; compute rate, ratio, and percent and draw and interpret bar graphs.
• Mental Capabilities:
  Ability to apply common sense to carry out instructions furnished in written or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
• Interpersonal:
  Ability to work well with others.

• Mid‑Senior level

• Full‑time

• Health Care Provider

• Hospitals and Health Care