Department:

11221 Advocate Aurora Health Corporate - WI Administration: Care Management

Status:

Part time

Benefits Eligible:

Yes

Hours Per Week:

20

Schedule Details/Additional Information:

about every 4th weekend and holiday rotation (1 Holiday/year). Day Shift.

Pay Range

$34.90 - $52.35

Job Title: Utilization Review RN

Location: Remote - Wisconsin
Employment Type: Part-Time

Schedule - Day shift M -F (0.5 FTE)

schedule is done quarterly (see proposed schedule below)

Week 1: Sat, Sun, Mon, Tues, Wed

Week 2: Off

Week 3: Mon thru Friday

Week 4: Off

Week 5: Sat, Sun, Mon, Tues, Wed

Week 6 Off.

Week 7: Mon thru Friday

Week 8: Off

Week 9: Sat, Sun, Mon, Tues, Wed

Week 10: Off

Week 11: Mon thru Friday

Week 12: Off

(1 Holiday/year). Day Shift.

Wisconsin RN licensure required

Position Summary
The Utilization Review RN is responsible for performing accurate and timely concurrent and retrospective reviews using established criteria to ensure appropriate utilization of healthcare resources. This role collaborates with physicians, hospital departments, and multidisciplinary teams to expedite care delivery, prevent delays, and maintain compliance with regulatory guidelines.

Major Responsibilities

Document utilization review activities per department and medical center standards in a timely manner.

Perform and document concurrent and retrospective reviews based on approved criteria.

Communicate effectively with healthcare teams, including physicians and ancillary services, to support timely care delivery.

Collaborate with managers, medical directors, and treatment teams to address utilization issues and ensure compliance.

Refer cases to physician advisors as needed for accurate status determination.

Stay current on healthcare regulations, reimbursement issues, and community resources.

Provide clinical updates to payers, coordinate denial activity, and manage avoidable delays.

Serve as an educator and resource for staff regarding admission status, acute care criteria, and regulatory requirements.

Develop and maintain relationships with community agencies to support patient and family needs.

Demonstrate age-specific care knowledge and skills across the patient lifespan.

Experience & Skills Required

Working knowledge of Microsoft Office (Excel, Outlook, PowerPoint, Word).

Understanding of quality and acute care patient needs related to care management.

Knowledge of Utilization Review criteria; must achieve 80% or greater on annual IRR competency exam.

Strong critical thinking skills for applying medical necessity criteria.

Excellent analytical, communication, and interpersonal skills for interaction with patients, families, physicians, and payers.

Ability to manage conflict and maintain positive professional relationships.

Commitment to professional growth and participation in department and system initiatives.

Licensure, Registration, and/or Certification Required:

Registered Nurse license issued by the state (WISCONSIN) in which the team member practices.

Education Required:

Bachelor's Degree in Nursing.

Experience Required:

Requires 3 years of experience in clinical nursing, With a strong preference in utilization and/or quality management.

Join our team and help ensure quality, efficient care for every patient!

Apply Today!

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or trainingPremium pay such as shift, on call, and more based on a teammate's jobIncentive pay for select positionsOpportunity for annual increases based on performance

Benefits and more

Paid Time Off programsHealth and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term DisabilityFlexible Spending Accounts for eligible health care and dependent care expensesFamily benefits such as adoption assistance and paid parental leaveDefined contribution retirement plans with employer match and other financial wellness programsEducational Assistance Program

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.