DescriptionWelcome Bonus: $2,500.00 for external candidates.Location: This position is located at our Dublin, OH campus with hybrid work from home flexibilityMultistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health.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 why we call ourselves 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 every requirement.The Utilization Review Nurse 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 doAssess and review all requests for inpatient medical services requiring clinical review against Quantum Health's adopted clinical review criteria.Conduct initial clinical reviews, concurrent reviews and retrospective reviews.Utilize Quantum Health's adopted clinical criteria during all aspects of the review process and document outcomes in authorization database.Facilitate discharge-planning process during daily concurrent review and post discharge, including arranging skilled nursing care, rehabilitation, home infusion and other outpatient ancillary services.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 health decisions.Provide re-direction of out of network service requests to in network whenever possible to ensure members obtain the optimum benefit.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 bringEducation / Licensure: Active license in good standing as aRegistered Nurse(RN) in the state of Ohio required. Licensed Practical Nurses (LPNs) currently employed by Quantum Health may also be considered.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 services preferred.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 implementingclinical services; Translate complex clinical concepts for non-clinical audiences.What's in it for youCompensation: 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 id