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SalaryJob Title: Utilization Review Nurse
Come join our team at Santiam Hospital & Clinics! We are a 4-star rated Hospital and voted 2021’s Best of the Mid-Valley for Best Hospital, Best Place to Have a Baby, and Best Local Surgery Center!
We are seeking a part time Utilization Review nurse to enhance our Utilization Review/care management team.
Santiam Hospital & Clinics is an independent, not-for-profit, 40 bed acute-care community-based hospital with 13 clinics across 8 specialties settled in the foothills of the Cascades serving many recreational sites as well as agricultural communities. We are an ever growing, progressive, up-to-date healthcare facility that is proud to serve our community and care for our friends and neighbors, ensuring the highest quality of care is delivered. Hourly wage is dependent on experience.
Job Summary: Onsite, (no remote), part time position, includes weekends and holidays.
Responsibilities:
- Perform case reviews within 24 hours of patient admission
- Review patient records to examine patient class
- Determine incorrect patient class assignments and reassign accordingly
- Recommend strategies to improve findings from each review
- Facilitate communication between clinical staff and insurance companies
- Work to solve pending claims and prevent claim denials
Qualification/Education/Requirements:
3-5 years discharge planning or inpatient care management experience preferred.
Knowledge of Utilization management principles, Swing Bed, home health care, skilled nursing facilities/long term care and durable medical equipment is highly desirable.
Required Qualifications
- Active RN license
- 2-5 years of clinical experience
- Microsoft Office proficiency
- Advanced verbal, written, and organization skills
- Previous UR or case management experience preferred
- Electronic Medical Record (EMR) experience preferred
- BSN preferred
- Proficient in use of Milliman Care Guidelines or Interqual Criteria set preferred
Benefits at a Glance:
401(k) Retirement plan
Health, dental and vision insurance for staff and family
PTO, holidays and extended medical leave bank
Hospital Incentive Plan (HIP)
Life insurance
Long-term disability Insurance
Staff discounts
Santiam Hospital and Clinics is an EEO Affirmative Action Race/Sex/Sexual Orientation/Gender Identity/National Origin/Veteran/Disability Employer.
