Utilization Review Nurse Registry

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: Registry, Registry 48 hours per 6 week schedule block; remote; on site requirement for 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 p