Registered Nurse (RN)- Utilization Review

Why work at TidalHealth?

Looking for a rewarding place to work? Choose TidalHealth. U.S. News & World Report, a global authority in hospital rankings and consumer advice, has named TidalHealth Peninsula Regional and TidalHealth Nanticoke as 2022-2023 High Performing hospitals for 11 challenging and elective health conditions; the highest award a hospital can earn for U.S. News' Best Hospitals Procedures & Conditions ratings. Located just 30 minutes from the beach, TidalHealth offers the widest array of specialty and subspecialty services such as neurosurgery, cardiothoracic surgery, joint replacement, emergency / trauma care, comprehensive cancer care, wound care and clinical trials and research. Take advantage of our tuition assistance and scholarship programs to grow both personally and professionally.

Utilization Review RN Position Summary

The Utilization Review - RN is a registered nurse who is responsible for facilitating appropriate lengths of stay and reimbursement for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all service team members, patients, and families. Works with the leadership team to align the goals and visions. It is essential for RN to have general knowledge of payor industry, resource management and evidence-based clinical practice. Theoretical knowledge of the nursing and case management processes.

Utilization Review RN Position Requirements

• Current and valid license to practice as a RN
• BSN preferred
• Accreditation preferred
• 3 or more years of strong clinical experience
• Interqual or Milliman criteria preferred
• Excellent interpersonal communication and negotiation skills
• Strong analytical, data management and PC skills
• Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
• Ability to work independently and exercise sound judgment in interactions with patients, families, providers and payors.

Utilization Review RN Benefits

Salary range : $72,072.00-$115,315.20 Commensurate with experience