The Utilization Review RN is a registered nurse who is responsible for facilitating appropriate lengths of stay and reimbursement for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all service team members, patients, and families. Works with the leadership team to align the goals and visions. It is essential for RN to have general knowledge of payor industry, resource management and evidence-based clinical practice. Theoretical knowledge of the nursing and case management processes. Utilization Review RN Position Requirements Current and valid license to practice as a RN BSN preferred Accreditation preferred 3 or more years of strong clinical experience Interqual or Milliman criteria preferred Excellent interpersonal communication and negotiation skills Strong analytical, data management and PC skills Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement Ability to work independently and exercise sound judgment in interactions with patients, families, providers and payors. Utilization Review RN Benefits At TidalHealth, team members working at least 36 hours per pay period based on 12-hour shift schedules or at least 37.5 hours for non 12-hour shift schedules and part-time team members working at least 30 hours or more on weekends only are eligible for benefits. Benefits include medical, prescription, vision, dental, flexible spending accounts, disability insurance plans, life insurance, paid time off plans, retirement plans, tuition assistance, employee assistance, and access to on-site childcare and a credit union.