Utilization Review Nurse - Casual

Utilization Review Nurse -

Casual Job Title Utilization Review Nurse Job Relationships Department:

Utilization Review Supervisor:

Utilization Review Coordinator Supervises:

None Job Summary Performs concurrent chart review and duties.

These include:

severity of illness and intensity of service evaluation, continued stay review and communication with third party payors as required, DRG assurance process, swing bed program eligibility determinations, prior authorizations for Hospital Based Outpatient Clinics and participation on the discharge planning team. Compensation We are committed to providing wage ranges for all open positions. Please note that the specific compensation for this role will be determined based on experience, education and internal equity considerations. The hourly wage range for this position is $39.48-$55.73. This range reflects the base salary for this position.

Key Accountabilities Conducts daily operations:

Daily chart review Analyzes patient records to determine medical necessity of admission and/or observation, treatment, and length of stay to comply with government and insurance company reimbursement policies. Preparation of medical justification documents to submit reimbursement claims for services provided and denials of reimbursement claims. Prior authorizations for Hospital Based Outpatient Clinics. Implements necessary procedural revisions to conform with current criteria from regulatory agencies: Provides individual consultation and education on utilization review to medical staff and nursing. Prepares and presents appropriate utilization review reports to the medical staff and executive committees. Participates as co-leader for the Utilization Committee. Assists the UR Coordinator in departmental and organizational goals and initiatives: Assists in departmental quality initiatives. Completes quality audits as needed. Completes the assigned tasks following the outlined time frame. Required Qualifications Current RN license with the Minnesota Board of Nursing, in good standing Two to five years of Medical-Surgical Nursing Must be able to speak, read, and write English proficiently to ensure safe and effective communication in a healthcare environment Preferred Qualifications Bachelor of Nursing Degree One to two years experience in Utilization Review One to two years directly related experience using InterQual Criteria or another healthcare criteria. Self-motivated and efficient Ability to work both as a team member and independently Strong communication, documentation, clinical and critical thinking skills. Working knowledge of utilization management / case management. Schedule Varying Days/Shifts Regular business hours during orientation Required to work at least one day a month to maintain competency Benefits Earned Safe and Sick Time (ESST) accrued on first paycheck Pension Plan ( PERA ) with 7.5% employer match Optional 457(b) Retirement Plans Loan Forgiveness Eligibility - PSLF + MN state programs for qualifying roles Employer-Provided Certifications + Continuing Education Additional perks: Free On-Site Parking, Qualified Bilingual Staff Program, Employee Assistance Program, and discounts on cafeteria, scrubs, and OTC pharmacy items About Us Northfield Hospital + Clinics is a trusted, independent healthcare system with more than 800 employees. We re recognized for our collaborative work environment and strong commitment to high-quality patient care and community impact. We re proud to be named to Becker s 2025 list of "100 Great Community Hospitals." Our services span the full spectrum of hospital and clinical care, with our main hospital located in Northfield, MN, and primary and specialty clinics in Northfield, Lakeville, Farmington, Faribault, and Kenyon-along with Urgent Care locations in Northfield, Lakeville, and Farmington. We offer care across 48 specialties and serve patients at 22 locations throughout the south metro and southern Minnesota. Whether you're just starting your career or bringing years of experience, you'll find meaningful opportunities, supportive teams, and a chance to make a real difference here. •This posting is not a complete list of duties or responsibilities. Job functions, schedules, and terms of employment may change in accordance with applicable laws, policies, and agreements.