Utilization Review Nurse

OVERVIEW Embark on an enriching nursing career at Redeemer Health, where you can select the clinical environment that matches your passion and skills.

Whether it's our hospital, home care services, or senior care communities, you are recognized as a valued clinical expert.

Serving southeastern Pennsylvania and New Jersey, we are home to a diverse, inclusive workforce committed to professional growth.

We offer competitive benefits, educational assistance, nursing scholarship opportunities, and a unique onboarding program that sets you up for long-term success while introducing you to our mission and celebrated service orientation.

Together, let's drive excellence in healthcare. SUMMARY OF JOB To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care as required by the payer.

Work with physician advisor to better manage denials and downgrades. CONNECTING TO MISSION : All individuals, within the scope of their position are responsible to perform their job in light of the Mission & Values of the Health System.

Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in our interactions with one another and in the services we provide.

RECRUITMENT REQUIREMENTS Registered Nurse : must have a current license in Pennsylvania from the Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs.

Bachelor degree preferred. Registered Nurse : a minimum of five or more years of acute care clinical nursing. Recent experience in a hospital, insurance company, or independent review company in utilization, quality review, homecare or case management Skills : Thorough understanding of managed care systems and utilization review criteria Working knowledge of managed care and third party reimbursement Experience with case management, evaluation / assessment of clients One hour of annual stroke education Basic computer skills required Advocacy and problem solving skills Excellent time management and strong written and verbal communication skills Possesses strong organizational and negotiation skills Possesses strong team work skills Strong organizational and prioritizing skills Knowledge of community resources Demonstrated leadership abilities Experience in the use of information systems EOE EQUAL OPPORTUNITY Redeemer Health is an equal opportunity employer.

We prohibit discrimination in employment due to race, color, gender, religion, creed, national origin, age, sex, sexual orientation, gender identity or expression, disability veteran status or any other protected classification required by law.