Utilization Review RN

Who You’ll Join:

Come join Santiam Hospital’s team of talented medical professionals and make a difference as our next Utilization Review Nurse.  You will play an instrumental role in improving healthcare outcomes by ensuring quality and optimizing resources. If you’re a dedicated RN with a strong background in clinical review and case management who is ready to be part of a collaborative team, we encourage you to apply!

Santiam Hospital and Clinics is one of only three independent, acute-care hospitals in Oregon. We specialize in a wide range of treatments, serving more than 40,000 patients annually.  Nestled in the historic city of Stayton, Oregon, our location provides a historic charm and quick access to the Pacific Northwest’s most scenic mountains and beaches, all within an hour’s drive.

Salary range: $46.01 - $67.57

Position Type: Remote

What You’ll Do:

• Functions Specific to Role as Utilization Review Registered Nurse
• Independently apply critical thinking skills to review and analyze Hospital patient health information records and use such assessments to make informed decisions about necessity and appropriateness of treatments and interventions delivered during the course of applicable inpatient or outpatient care.
• Use pertinent clinical review tools (e.g. criteria issued by MCG or InterQual®) during performance of utilization review for all admitted patients as appropriate designation for such patients is determined.
• Ensure that pre-authorizations for indicated treatments or procedures have been obtained and are accurately documented.
• Facilitate communication between healthcare teams, insurance providers, and other stakeholders in manner that supports coordinated and efficient care delivery.
• Collaborate with Medical Staff professionals to develop and implement comprehensive patient care plans.

• Gain insight into patient progress, care goals, and discharge planning through review of EHR and discussion with Care Management Service staff.
• Analyze patient clinical outcomes and other data to identify opportunities for improvement in care quality and cost-efficacy.
• Educate applicable Medical Staff and Hospital clinical staff about patient care best practices and cost management considerations for rendered services.
• Maintain current knowledge about applicable healthcare regulations, insurance guidelines, and evidence-based care delivery practices, and actively apply and share such knowledge during job performance.
• Perform other duties assigned by Chief Nursing Officer.

What You’ll Need:

• Current and unrestricted RN license
• 3+ years of acute care hospital bedside experience
• 3+ years acute care hospital case management, utilization review and discharge planning experience
• Proficient in use of Milliman Care Guidelines or Interqual Criteria set preferred
• Knowledge of current healthcare regulations and guidelines
• Ability to work independently and efficiently in a remote environment
• Proficient in using EPIC and other relevant software
• Advanced verbal, written, and organization skills
• BSN preferred

Benefits for Eligible Positions:

• Medical, Vision and Dental Insurance
• PTO and holiday pay
• Employee Referral Program
• 401(k) Retirement
• Life Insurance
• Long Term Disability
• Employee Discounts
• Bilingual Pay Differential for eligible positions
• Public Service Loan Forgiveness for eligible positions
• Tuition Assistance for eligible positions

Why Santiam Hospital?

At Santiam Hospital & Clinics, we pride ourselves on fostering a supportive and inclusive work environment where every team member is valued and empowered to make a difference. Our commitment to excellence in patient care is matched by our dedication to employee growth and well-being. As part of our team, you’ll have access to cutting-edge medical technology, ongoing professional development opportunities, and a collaborative culture that encourages innovation and teamwork. Join us at Santiam Hospital & Clinics, where your skills and compassion will be appreciated, and together, we can make a positive impact on the health and lives of our community.

With 13 clinics offering 8 specialties, you’ll be part of a diverse and dynamic healthcare community. We’re proud to have been named the 2025 Best Place to Have a Baby, Best Hospital as well as receiving accolades for our Surgery Center, Medical Facility and Women’s Clinic, reflecting our unwavering commitment to providing exceptional care for our patients.

Santiam Hospital & Clinics is a drug-free workplace in accordance with the Drug-Free Workplace Act of 1988 and an EEO Affirmative Action Race/Sex/Sexual Orientation/Gender Identity/National Origin/Veteran/Disability Employer.