Utilization Review RN: Optimize Care & Outcomes

Wilson Health; Sidney (OH); Presencial; USD 78 000 - 110 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Access to on-site gym

Tuition Assistance Program

Employer-provided life insurance

Resumo da oferta

Wilson Health is seeking a Utilization Review Nurse (RN) for a full-time role in Case Management. The UR RN conducts prospective, concurrent, and retrospective reviews to ensure appropriate utilization of hospital services, accurate patient status, and payer compliance.

The position involves collaboration with physicians, nursing staff, case management, medical records, and billing, to support timely documentation, correct patient placement, and optimal reimbursement.

Qualificações

• Current, unrestricted RN license in the applicable state.
• Graduate of an accredited nursing program.
• Strong assessment and critical-thinking skills.
• Working knowledge of medical terminology and documentation.

Responsabilidades

• Conduct medical necessity and level-of-care reviews for inpatient, observation, emergency services.
• Review clinical documentation and orders to determine appropriateness of admission and continued stay.
• Identify cases not meeting criteria and communicate concerns to care team.
• Support discharge planning and coordination with case management and payers.

Conhecimentos

RN licensure

Critical thinking

Medical terminology

Documentation

Formação académica

RN-degree or diploma

Ferramentas

EMR systems

Computer basics

Descrição da oferta de emprego

Wilson Health is seeking a Utilization Review Nurse (RN) for a full-time role in Case Management. The UR RN conducts prospective, concurrent, and retrospective reviews to ensure appropriate utilization of hospital services, accurate patient status, and payer compliance.

The position involves collaboration with physicians, nursing staff, case management, medical records, and billing, to support timely documentation, correct patient placement, and optimal reimbursement.