Utilization Review Nurse

Silver Cross Hospital Job Opportunity

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.

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

• 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

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

• 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

Various, Day; weekend rotation; holiday rotation; occasional on site requirement for meetings and mandatory training

CONTINUUM OF CARE