Utilization Review Nurse

Hello humankindness

Dignity Health’s Mercy Gilbert Medical Center is nationally known for our holistic approach to medicine, and here, you are a part of a “golden thread” of compassionate care that connects staff and patients. While walking through the Healing Garden–with it’s intertwined pathways, garden areas and fountains–you’re reminded of our dedication to honoring the whole person. Embracing total well-being, then seeing patients and their loved ones respond positively, is personally rewarding to you.   

Mercy Gilbert is a modern, 212-bed, acute care, not-for-profit community hospital in the Phoenix area’s East Valley. We offer a full breadth of care, from emergency and cardiovascular to pediatric, orthopedic and diagnostic services. Since opening in June 2006, we have been named the “#1 Small-Sized Acute Care Hospital” by Arizona Business Magazine and the “#1 Healing Hospital in the Nation” by Baptist Healing Trust. We’ve also been named “Business of the Year” by the Gilbert Chamber of Commerce. You’re proud of these awards, but even more, you’re proud of the solace, serenity and reprieve you’re able to provide here. 

Living in Phoenix’s relatively new suburb of Gilbert, Arizona, you treasure its old-world charm mixed with modern-day luxuries. This urban center has all the shopping, restaurants and culture your heart desires, with all the outdoor activities your spirit needs. There are nearby lakes for boating, wakeboarding and water skiing, while Flagstaff and Sunrise offer winter skiing and snowboarding. Arizona has four professional sports teams, and you’re a year-round fan. You look forward to all the activities, but then again, at the end of a busy day, taking a moment to relax poolside and reflect sounds good, too. The scenery, the climate and the culture present the perfect backdrop for your healing work at Mercy Gilbert. 

Now is the perfect time to come grow your career with one of Arizona's Most Admired Companies.  Look for us on Facebook and follow us on Twitter.

For the health of our community ... we are proud to announce that we are a tobacco-free campus.

Under the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of resources; promote quality patient care; assist with patient care management; comply with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical, financial, operational and patient satisfaction outcomes.

Skills needed:

Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS. Working knowledge with INTERQUAL or Milliman preferred. Excellent written and verbal communication skills with the ability to interact with patients/family, clinical staff, insurance providers and post-acute care providers.

Responsibilities:

• Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.  Reviews include admission, concurrent and post discharge for appropriate status determination.
• Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
• Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers. 
• Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
• Collaborates with facility RN Care Coordinators to ensure progression of care.
• Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.

Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. 

Minimum:

• Graduate of an accredited school of nursing
• Minimum two (2) years of acute hospital clinical  experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience
• RN: AZ or Compact License
• Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used

Preferred:

• Bachelor's Degree in Nursing (BSN) or related healthcare field 
• At least five (5) years of nursing experience
• Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification