Registered Nurse (RN) - Utilization Review

TidalHealth • Berlin, MD

29d

About The Position

Utilization Review RN assumes Care Coordination and Utilization Review functions for all patients. Facilitates the collaborative management of patient to prevent E.D. recidivism, un-necessary admissions and re-admissions. Initiates clinical review, denials / appeals and medical necessity for those being placed in a clinical bed to ensure "right patient / right level of care."

Requirements

• RN License
• American Heart Association Healthcare Provider CPR and ACLS certification
• A Bachelors in Nursing (BSN) degree is preferred and must be obtained within 5 years from date of hire.
• Must have 2-5 years clinical experience and prior experience in Case Management.
• Must have knowledge of community based resources.
• Ability to multi-task and perform functions in a fast-paced setting, and knowledge of insurance and associated coordination of healthcare services is required.

Nice To Haves

• Prior Utilization Review experience and knowledge of MCG (Milliman) criteria is preferred.

Benefits

• Benefits include medical, prescription, vision, dental, flexible spending accounts, disability insurance plans, life insurance, paid time off plans, retirement plans, tuition reimbursement and more!

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Number of Employees: 5,001-10,000 employees