Registered Nurse, RN - Transplant Utilization Review - $2,500 Sign On
Posted on: September 24, 2022
Welcome Bonus: $2,500.00 for external candidates.
Location: This position is located at our Dublin, OH campus.
We're on a mission to make healthcare simpler and more effective.
We fight to ensure our members get the care they need, when they
need it, at the most affordable cost - that's what makes us
Healthcare Warriors . We're committed to building diverse and
inclusive teams, so if you're excited about this position, we
encourage you to apply - even if your experience doesn't match
The Registered Nurse (RN) - Transplant Utilization Review reviews
and processes medical service requests for members of Quantum
Health's employer groups in an inpatient setting. This Nurse
acquires all clinical documentation in order to process the
requests within the designated timeframes indicated. The
Utilization Review (UR) Nurse also functions as a clinical resource
to other Quantum Health associates in Precertification, Patient
Services/Care Coordination, Personal Care Guide Nurses, Client
Services and Sales.
What you'll do
- Assess and review all requests for inpatient medical services
requiring clinical review against Quantum Health's adopted clinical
- Conduct initial clinical reviews, concurrent reviews and
- Utilize Quantum Health's adopted clinical criteria during all
aspects of the review process and document outcomes in
- Facilitate discharge-planning process during daily concurrent
review and post discharge, including arranging skilled nursing
care, rehabilitation, home infusion and other outpatient ancillary
- Communicate with patients, providers, facilities and internal
partners regarding outcomes.
- Coordinate integrated health management services for each
patient and provide benefit and health information to patients,
caregivers, providers and facilities so they can make informed
- Provide re-direction of out of network service requests to in
network whenever possible to ensure members obtain the optimum
- Identify potential cases for high risk/high cost/chronic
condition and refer to the appropriate case management team.
- Research vague or questionable procedures and present findings
to the Chief Medical/Physician Peer Reviewer for opinion; Provide
timely notification of potential non-certifications.
- All other duties as assigned.
What you'll bring
- Education / Licensure: Active license in good standing as a
Registered Nurse (RN) in the State of Ohio required.
- 2+ years of clinical experience with direct patient care in a
hospital setting required.
- Strong administrative/technical skills; Comfort working on a PC
using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video
conferencing (Teams & Zoom), and telephones efficiently.
- Experience in care management/coordination programs and
- Excellent verbal and written communication skills. Comfortable
communicating with members and providers via phone regularly
throughout the day.
- Trustworthy and accountable behavior, capable of viewing and
maintaining confidential personal information daily.
- Ability to communicate effectively with members and providers
in implementing clinical services; Translate complex clinical
concepts for non-clinical audiences.
What's in it for you
- Compensation: Competitive base pay, incentive plans and
employee referral bonuses.
- Coverage: Health, vision and dental featuring our best-in-class
healthcare navigation services, along with life insurance, legal
and identity protection, adoption assistance, EAP, Teladoc services
- Retirement: 401(k) plan with up to 4% employer match and full
vesting on day one.
- Balance: Paid Time Off (PTO), 7 paid holidays, parental leave,
volunteer days, paid sabbaticals, and more.
- Development: Tuition reimbursement up to $5,250 annually,
certification/continuing education reimbursement, discounted higher
education partnerships, paid trainings and leadership
- Culture: Recognition as a Best Place to Work for 15+ years,
dedication to diversity, philanthropy and sustainability , and
people-first values that drive every decision.
- Environment: A modern workplace with a casual dress code, open
floor plans, full-service dining, free snacks and drinks,
complimentary 24/7 fitness center with group classes, outdoor
walking paths, game room, notary and dry-cleaning services and
more! Check out our home:
What you should know
- Internal Associates: Already a Healthcare Warrior? Apply
internally through Jobvite.
- Process: Application > Phone Screen > Online
Assessment(s) > Interview(s) > Offer > Background
- Diversity, Equity and Inclusion: Quantum Health welcomes
everyone. We value our diverse team and suppliers, we're committed
to empowering our ERGs, and we're proud to be an equal opportunity
- Agencies: Quantum Health does not accept unsolicited resumes or
outreach from third-parties. Absent a signed MSA and
request/approval from Talent Acquisition to submit candidates for a
specific requisition, we will not approve payment to any third
- Sponsorship: Applicants must be legally authorized to work in
the United States on a permanent and ongoing future basis without
requiring sponsorship. --
Note: Compensation information published by job boards are
estimates and not verified by Quantum Health. Details surrounding
compensation will be disclosed throughout the interview process.
Compensation offered is based on the candidate's unique combination
of experience and qualifications related to the position.
Keywords: quantum-health, Columbus , Registered Nurse, RN - Transplant Utilization Review - $2,500 Sign On, Healthcare , Dublin, Ohio
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