Join Santiam Hospital’s team of talented medical professionals and make a difference as our next Utilization Review Nurse. You will play an instrumental role in improving healthcare outcomes by ensuring quality and optimizing resources.
Salary range: $46.01 - $67.57
Position Type: Remote
What You’ll Do
Functions Specific to Role as Utilization Review Registered Nurse
Independently apply critical thinking skills to review and analyze Hospital patient health information records and use such assessments to make informed decisions about necessity and appropriateness of treatments and interventions delivered during the course of applicable inpatient or outpatient care.
Use pertinent clinical review tools (e.g. criteria issued by MCG or InterQual®) during performance of utilization review for all admitted patients as appropriate designation for such patients is determined.
Ensure that pre-authorizations for indicated treatments or procedures have been obtained and are accurately documented.
Facilitate communication between healthcare teams, insurance providers, and other stakeholders in manner that supports coordinated and efficient care delivery.
Collaborate with Medical Staff professionals to develop and implement comprehensive patient care plans.
Gain insight into patient progress, care goals, and discharge planning through review of EHR and discussion with Care Management Service staff.
Analyze patient clinical outcomes and other data to identify opportunities for improvement in care quality and cost‑efficacy.
Educate applicable Medical Staff and Hospital clinical staff about patient care best practices and cost management considerations for rendered services.
Maintain current knowledge about applicable healthcare regulations, insurance guidelines, and evidence‑based care delivery practices, and actively apply and share such knowledge during job performance.
Perform other duties assigned by Chief Nursing Officer.
What You’ll Need
Current and unrestricted RN license
3+ years of acute care hospital bedside experience
3+ years acute care hospital case management, utilization review and discharge planning experience
Proficient in use of Milliman Care Guidelines or InterQual Criteria set preferred
Knowledge of current healthcare regulations and guidelines
Ability to work independently and efficiently in a remote environment
Proficient in using EPIC and other relevant software
Advanced verbal, written, and organization skills
BSN preferred
Benefits For Eligible Positions
Medical, Vision and Dental Insurance
PTO and holiday pay
Employee Referral Program
401(k) Retirement
Life Insurance
Long Term Disability
Employee Discounts
Bilingual Pay Differential for eligible positions
Public Service Loan Forgiveness for eligible positions
Tuition Assistance for eligible positions
Why Santiam Hospital
At Santiam Hospital & Clinics, we pride ourselves on fostering a supportive and inclusive work environment where every team member is valued and empowered to make a difference. Our commitment to excellence in patient care is matched by our dedication to employee growth and well‑being. As part of our team, you’ll have access to cutting‑edge medical technology, ongoing professional development opportunities, and a collaborative culture that encourages innovation and teamwork. Join us at Santiam Hospital & Clinics, where your skills and compassion will be appreciated, and together, we can make a positive impact on the health and lives of our community.
With 13 clinics offering 8 specialties, you’ll be part of a diverse and dynamic healthcare community. We’re proud to have been named the 2025 Best Place to Have a Baby, Best Hospital as well as receiving accolades for our Surgery Center, Medical Facility and Women’s Clinic, reflecting our unwavering commitment to providing exceptional care for our patients.
Santiam Hospital & Clinics is a drug‑free workplace in accordance with the Drug‑Free Workplace Act of 1988 and an EEO affirming action Race/Sex/Sexual Orientation/Gender Identity/National Origin/Veteran/Disability Employer.