Utilization Review-RN

Summary

The Utilization Review-RN assesses and analyzes medical records and patient data to ensure that healthcare services are provided in an efficient, effective, and safe manner. Collaborates with the patient, family, physician, interdisciplinary team, and payor representative to assess, plan, implement, coordinate, monitor, analyze and evaluate options and services to promote optimal patient outcomes. Monitors the provision of cost-effective care to ensure care is given in the most clinically appropriate setting. Facilitates compliance with regulatory requirements and organizational performance standards, including demonstration of core competencies.

This role is 100% remote in our remote-eligible states. We are accepting applicants that can work remotely and live in AZ, FL, GA, IA, IL, IN, KY, MI, MO, MT, NC, NE, NV, TN, TX, OH, WA, or WI.

Qualifications

Education

Associates Degree or Diploma in Nursing is required.

Bachelors Degree in Nursing is preferred.

Experience

2 years of clinical, care management, or related experience is required.

Prior inpatient hospital nursing, utilization review and quality/process improvement experience is preferred.

Microsoft Office experience required. InterQual or MCG experience preferred.

Certifications, Licenses and Registrations

Licensed as a Registered Nurse (RN) in both IL and WI is required.

Colleagues may begin employment with either an IL or WI Registered Nurse (RN) license, but must obtain other state required license within 1 year of hire.

Wisconsin: RNs may practice with a valid multi-state RN license as outlined in the Nurse Licensure Compact rules.

Physical Requirements: Administrative (https://hshs.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=250526&hashed=-655207489)

Overview

Throughout communities in Illinois and Wisconsin, 13 hospitals, numerous community-based health centers and clinics, our 13,000 colleagues have built a culture based on our solid core values of respect, care, competence, and joy. These are the ideals we believe in, work by, and live each day.

Built upon more than 145 years of service to the communities we serve, we now look to the future and our place in it as a health care system that strives to continually improve processes, procedures, and outcomes with the latest and most advanced technologies and treatments.

Regardless of how far our passion for excellence carries us, our focus will always remain on the most important person in our entire organization: The patient.

HSHS requires COVID-19 vaccines or an approved medical or religious exemption for all colleagues.

HSHS and affiliates is an Equal Opportunity Employer (EOE).

HSHS is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce.

Benefits

HSHS provides a benefits package designed to support the overall well-being of our colleagues including their physical, emotional, financial, spiritual, and work health. Colleagues budgeted to work at least 32 hours per pay period are eligible for HSHS benefits.

Comprehensive and affordable health coverage includes medical, prescription, dental and vision coverage for full-time and part-time colleagues.

Paid Time Off (PTO) combines vacation, sick, and personal days into one balance to allow you the flexibility to use your time off as you need.

Retirement benefits including HSHS contributions.

Education Assistance benefits include up to $4,000 of educational assistance each calendar year and tuition discounts to select colleges with no waiting period.

Adoption Assistance provides financial support up to $7,500 for colleagues growing their families through adoption to reimburse application and legal fees, transportation, and more!

Other benefits include: Wellness program with incentives, employer-paid life insurance and short-term and long-term disability coverage, flexible spending accounts, employee assistance program, ID theft coverage, colleague rewards and recognition program, discount program, and more!

Education

Associates Degree or Diploma in Nursing is required.

Bachelors Degree in Nursing is preferred.

Experience

2 years of clinical, care management, or related experience is required.

Prior inpatient hospital nursing, utilization review and quality/process improvement experience is preferred.

Microsoft Office experience required. InterQual or MCG experience preferred.

Certifications, Licenses and Registrations

Licensed as a Registered Nurse (RN) in both IL and WI is required.

Colleagues may begin employment with either an IL or WI Registered Nurse (RN) license, but must obtain other state required license within 1 year of hire.

Wisconsin: RNs may practice with a valid multi-state RN license as outlined in the Nurse Licensure Compact rules.

Physical Requirements: Administrative (https://hshs.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=250526&hashed=-655207489)

The Utilization Review-RN assesses and analyzes medical records and patient data to ensure that healthcare services are provided in an efficient, effective, and safe manner. Collaborates with the patient, family, physician, interdisciplinary team, and payor representative to assess, plan, implement, coordinate, monitor, analyze and evaluate options and services to promote optimal patient outcomes. Monitors the provision of cost-effective care to ensure care is given in the most clinically appropriate setting. Facilitates compliance with regulatory requirements and organizational performance standards, including demonstration of core competencies.

This role is 100% remote in our remote-eligible states. We are accepting applicants that can work remotely and live in AZ, FL, GA, IA, IL, IN, KY, MI, MO, MT, NC, NE, NV, TN, TX, OH, WA, or WI.