Utilization Review Nurse

Department:

11221 Advocate Aurora Health Corporate - WI Administration: Care Management

Status:

Part time

Benefits Eligible:

No

Hours Per Week:

0

Schedule Details/Additional Information:

Zero assigned

staffing to fill PTO/LOA, etc. Dept runs day shift, 7 days/week.

with a strong preference for availability 8-hours Saturday

Minimum of 8 hours a month -

One Holiday a year rotating each year

Department is closed Thanksgiving and Christmas

Pay Range

$35.50 - $53.25

Utilization Review Nurse (RN) - per diem role

Position Summary

The Utilization Review Nurse is responsible for coordinating and performing utilization management (UM) activities to ensure appropriate resource use, regulatory compliance, and high-quality patient care. This role partners closely with physicians, interdisciplinary teams, and external stakeholders to support efficient care delivery, minimize delays, and optimize patient outcomes.

Major Responsibilities

• Conducts and documents utilization review activities in accordance with department and medical center standards, ensuring timely and accurate concurrent and retrospective reviews using established criteria.
• Collaborates effectively with the healthcare team, including medical staff, hospital departments, and ancillary services, to expedite care delivery and avoid delays.
• Participates in multidisciplinary teams to support care coordination, implement utilization management strategies, and report key activities.
• Partners with managers, physicians, medical directors, and treatment teams to address patient care issues and align with best practices.
• Refers cases to Physician Advisors as needed to ensure accurate patient status determination and compliance with regulatory guidelines.
• Maintains knowledge of healthcare regulations, reimbursement practices, and factors impacting length of stay and resource utilization.
• Communicates clinical updates to payers and external review organizations, manages denial activity, and identifies and resolves avoidable delays.
• Develops and sustains strong relationships with community agencies and external partners to support patient and family needs.
• Serves as a subject matter expert and educator for staff on utilization management, admission status, and regulatory requirements.
• Delivers age-appropriate care, demonstrating understanding of growth and development across the lifespan and applying this knowledge to patient assessment and care planning.

Licensure, Registration, and/or Certification Required

• Active Registered Nurse (RN) license in the state of Wisconsin

Education Required

• Bachelor's Degree in Nursing (BSN)

Experience Required

• Typically requires 3 years of experience in clinical nursing, utilization review, and/or quality management

Schedule:

Zero assigned

staffing to fill PTO/LOA, etc. Dept runs day shift, 7 days/week.

with a strong preference for availability 8-hours Saturday

Minimum of 8 hours a month -

One Holiday a year rotating each year

Department is closed Thanksgiving and Christmas

Knowledge, Skills & Abilities

• Proficiency in Microsoft Office (Excel, Outlook, PowerPoint, Word) or similar tools
• Strong understanding of utilization review criteria and acute care patient needs
• Demonstrated competency in InterRater Reliability (IRR) with a score of 80% or higher
• Critical thinking skills to evaluate clinical scenarios and apply medical necessity criteria
• Excellent communication and interpersonal skills with the ability to collaborate with patients, families, physicians, and payers
• Conflict resolution skills with a focus on achieving positive, collaborative outcomes
• Ability to build and maintain strong professional relationships across disciplines
• Commitment to ongoing professional development and active participation in organizational initiatives

Why Join Us

• Collaborative team environment committed to high-quality patient care
• Opportunity to influence patient outcomes and care delivery efficiency
• Professional growth within a leading healthcare organization

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 training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

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.