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Utilization Review Nurse
Silver Cross HospitalUtilization Review Nurse performing medical record reviews for severity of illness and service intensity. Acting as a liaison for external review agencies and ensuring compliance with regulations.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical record review, ensuring compliance with clinical norms and regulations while effectively communicating with external review organizations. Possesses strong critical thinking and organizational skills to evaluate care plans and manage variances in patient care.
Highest-signal resume keywords
Utilization Review ExperienceRegistered Nurse (RN) LicensureCritical Thinking SkillsExcellent Communication SkillsTime Management Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Medical Record ReviewClinical Database DocumentationVariance IdentificationPlan of Care EvaluationCompliance Monitoring
Soft Skills
OrganizedEfficient Time ManagementEffective Communication
Certifications & Qualifications
Current CPRBSN Preferred
Industry Keywords
Clinical NormsHospital NursingHospital Case ManagementInsurance Case ManagementUtilization Management
About the role
Key responsibilities & impact- Performs medical record review for severity of illness and intensity of service
- Liaison function with external review agencies to ensure compliance with regulations
- Identifies variance from established pathways
- 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
- 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
Requirements
What you’ll need- Knowledge of clinical norms
- Excellent communication skills
- Critical thinking skills
- Organized and efficient time management skills
- 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
Benefits
Comp & perks- Medical, Dental and Vision plans
- Life Insurance
- Flexible Spending Account
- Other voluntary benefit plans
- PTO and Sick time
- 401(k) plan with a match
- Wellness program
- Tuition Reimbursement