RN, Registered Nurse -Utilization Review

Licensure:

Current and a

ctive license as a Registered Nurse (RN) in the state of Ohio.  Licensed Practical Nurses (LPNs) currently employed by Quantum Health may also be considered

.

Minimum of 2 years clinical experience with direct patient care required in an inpatient hospital setting

Coverage:

Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.

Retirement:

401(k) plan with up to 4% employer match and full vesting on day one.

Balance:

Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.

The

Utilization Review Nurse

is responsible for reviewing and processing medical services requests for members of Quantum Health’s employer groups in an inpatient setting and transitions in relation. The nurse is responsible for processing all clinical documentation and appropriately reviewing the services requested against plan language and appropriate criteria; within the designated time frames indicated. The Utilization Review Nurse also partners with providers and facilities to assist with discharge planning. The Utilization Review Nurse provides the highest level of clinical service both internally and externally to promote quality, medically necessary, cost effective care.

Assess and review all requests for inpatient medical services and transitions in relation requiring clinical review against plan language and the appropriate clinical criteria. Conduct initial clinical review, concurrent review, and retrospective review.

Utilize subject matter expertise, critical thinking, and clinical knowledge to make independent decisions and determinations, following Quantum Health workflows.