Utilization Review Rn Full-time Days

Trinityrailwayexpress

Hybrid
Hospital case management
Utilization review and discharge planning
Medical necessity criteria application
This role provides hospital case management and utilization review collaboratively determining level of care needs beyond acute care and ensuring a smooth transition to the next level of care and services

Job Summary

  • This role provides hospital case management and utilization review collaboratively determining level of care needs beyond acute care and ensuring a smooth transition to the next level of care and services.
  • The position requires coordination of social services integration, adherence to regulatory compliance, and active collaboration with physicians and clinical team members to optimize patient outcomes and resource utilization.
  • The organization honors the dignity of every person and embraces differences to deliver compassionate, person-centered care while being an Equal Opportunity Employer.

Matching Summary

This role provides hospital case management and utilization review collaboratively determining level of care needs beyond acute care and ensuring a smooth transition to the next level of care and services.

Skills & Requirements

Must-have

  • Hospital case management
  • Utilization review and discharge planning
  • Medical necessity criteria application
  • Coordination with physicians and care teams
  • Knowledge of CMS regulatory requirements
  • Concurrent medical record review

Nice-to-have

  • Experience with Epic Utilization Review
  • Behavioral Health diagnoses knowledge
  • Communication with health insurance companies
  • Patient advocacy and education
  • Hybrid onsite and remote work

Key Requirements

  • RN license in Idaho or Oregon
  • BSN required; Master's preferred
  • Minimum 2 years hospital clinical experience
  • Proof of Oregon RN licensure application within 90 days
  • Residency establishment with Idaho Board of Nursing within 60 days if multistate license

Work Rights

RN license in Idaho or Oregon required

Tailored Resume

Cover Letter