Why ThedaCare?   

Living A Life Inspired!

Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. 

At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility.  A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits, with a whole-person approach to wellness –

Lifestyle Engagemente.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support  

Access & Affordabilitye.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!

Summary :The Utilization Review nurse provides a positive impact to the institution through interaction with physicians, nurses, and other patient care givers to ensure that medical record documentation is incorporated in clinical reviews provided to the payer. Monitors and evaluates care to ensure care is medically necessary, provided in the appropriate setting, and follows governmental and regulatory agency standards.

Job Description:

Key Accountabilities

Prioritize patient reviews based on status, payer, review dates, day of the week, medical record review, and application of clinical review criteria. Collaborates with the in-house care manager, maintains rapport and communication. Communicates Code 44’s to in-house care manager.Works collaboratively with peers to achieve daily work as evidenced by appropriate and timely communication which is respectful and clear. Sensitive to the workload of peers and shares responsibilities, fills in and offers to help. Actively participates in departmental process improvement team, planning, implementation, and evaluation of activities.Demonstrates active collaboration with other members of the health care team to achieve outcomes and goals, including CMS indicators. Responsible for work assigned to UR. Documentation will reflect all work and communication related to other teams. Second-level physician reviews will be sent as required and responses/actions reflected in documentation.Maintains positive, open communication with all team members. Educates client and medical staff regarding utilization review program. Maintains a calm, rational, professional demeanor when dealing with others, even in situations involving conflict or crisis. Computer phones, teams, host system EMR and email will be utilized and answered in a timely fashion. Staff are expected to respond to and/or acknowledge communication from all team members. Staff must be available as designated for meetings or training online unless prior arrangements are made.Conducts medical necessity review of all admissions. Utilizes approved clinical review criteria to determine medical necessity for admissions including appropriate patient status and continued stay reviews. Provides inpatient and observation (if indicated) clinical reviews for commercial carriers within one business day of admission. Collaborate with the in-house staff and/or physician to clarify information, obtain needed documentation, present opportunities, and educate. Receives and writes/enters verbal status orders after collaborating with the attending physician.Complies with client and department policies and procedures, including confidentiality and patient’s rights. Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilitiesPerforms other duties as assigned. Meet and maintain productivity and quality audits

Qualifications

Bachelors of Science in Nursing (BSN) or LPNCurrent Wisconsin compact RN License, without impactAmerican Heart Association Healthcare Provider Basic Life Support (BLS)Prior ICU, ED, PACU experience preferred

Physical Demands

Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twenty-five (25) pounds without assistanceJob classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

Work Environment

Normally works in climate-controlled office environmentFrequent sitting with movement throughout office spaceUse of computers throughout work dayFrequent use of keyboard with repetitive motion of hands, wrist and fingers

Day shift hours

Scheduled Weekly Hours:20Scheduled FTE:0.5Location:Corporate 1818 N. Meade Street - Appleton,WisconsinOvertime Exempt:No