Utilization Review Nurse

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

The Utilization Review Nurse performs clinical reviews to determine the medical necessity of requested services. The URN obtains clinical information and utilizes IHA policy and/or defined criteria to determine medical necessity, and if necessary, will consult with the Associate Medical Director for all requests that do not meet criteria or IHA policy.

• Active, current, unrestricted, and licensed registered nurse required. Associates degree in health related field; BSN preferred.

• Three (3) years of clinical experience in acute hospital care and/or three (3) years of utilization review experience required.

• Previous experience in managed care preferred.

• Clinical knowledge of the health or social work needs for the population served.

• Demonstrated ability to identify barriers to a successful care management path.

• Demonstrated ability to interact effectively with physicians and other members of the health care system.

• Proficient PC and Windows skills required, including MS Office.

• Excellent problem-solving abilities and time management skills.

• Excellent written, verbal and interpersonal communication skills.

• Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments.

• Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

• Provide high quality, professional utilization management services: (medical necessity review for Prior Authorization, pre-certification and concurrent review.)

• Prompt, courteous, and error free in performing utilization management functions.

• Available to answer inbound phone calls within required timeframes.

• Maintain quality of reviews and documentation by demonstrating sound judgment, excellent analytical and communications skills with attention to detail, utilizing designated criteria and/or IH policy as required.

• Complete requests in compliance with designated turn around time.

• Maintain accurate records:

  • Clear documentation of clinical information for medical necessity review of all requests, procedures, admissions and concurrent review.

  • Accurate documentation of criteria, IH policy or AMD review in Case notes.

  • Complete and timely follow through for disposition of cases - MD reviews, chart reviews, audits, case management referrals, etc.

  • Provide technical and professional expertise.

  • Demonstrate accurate understanding of contractual issues for all employer groups.

  • Ability to ascertain and gather appropriate information for completion of inquiry (i.e. medical necessity).

  • Maintain current level of knowledge of nursing, medical and health trend issues.

  • Exhibit proactive approach to problem solving.

  • Act as resource for professional information.

  • Ability to utilize appropriate resource material.

Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $35.50 - $38.00 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.