Registered Nurse (RN) Utilization Review PRN
Department: 11221 Advocate Aurora Health Corporate - WI Administration: Care Management Status: Part time
Benefits
Eligible: No Hours Per Week: 0 Schedule Details/Additional Information: 0 FTE Remote Day shift Minimum of 16 hours per month, which includes one 8-hour Saturday per Month One holiday per year on rotation Pay Range: $35.50 - $53.25 Registered Nurse (RN) Utilization Review PRN Wisconsin RN licensure required Where You Will Work The Utilization Review RN is responsible for performing accurate and timely concurrent and retrospective reviews using established criteria to ensure appropriate utilization of healthcare resources. This role collaborates with physicians, hospital departments, and multidisciplinary teams to expedite care delivery, prevent delays, and maintain compliance with regulatory guidelines. We're Looking For Registered Nurse license issued by the state (WISCONSIN) in which the team member practices. Bachelor's Degree in Nursing Requires 3 years of experience in clinical nursing, With a strong preference in utilization and/or quality management. Working knowledge of Microsoft Office (Excel, Outlook, PowerPoint, Word). Understanding of quality and acute care patient needs related to care management. Knowledge of Utilization Review criteria; Strong critical thinking skills for applying medical necessity criteria. Excellent analytical, communication, and interpersonal skills for interaction with patients, families, physicians, and payers.
What You Will Do
Document utilization review activities per department and medical center standards in a timely manner. Perform and document concurrent and retrospective reviews based on approved criteria. Communicate effectively with healthcare teams, including physicians and ancillary services, to support timely care delivery. Collaborate with managers, medical directors, and treatment teams to address utilization issues and ensure compliance. Refer cases to physician advisors as needed for accurate status determination. Stay current on healthcare regulations, reimbursement issues, and community resources. Provide clinical updates to payers, coordinate denial activity, and manage avoidable delays. Serve as an educator and resource for staff regarding admission status, acute care criteria, and regulatory requirements. Develop and maintain relationships with community agencies to support patient and family needs. Demonstrate age-specific care knowledge and skills across the patient lifespan. Join our team and help ensure quality, efficient care for every patient! Be the Nurse Who Redefines Care. At Advocate Health, being a nurse means more than delivering exceptional clinical care—it means leading with purpose, compassion, and boldness. As part of our One Advocate Nurse community, you’ll join a unified team committed to lifting others up, embracing innovation, and creating inclusive spaces where everyone can thrive. You’ll be empowered to think boldly, collaborate with humility, and drive change through fearless curiosity. Whether you're at the bedside, in the community, or advancing care through research and education, you’ll help shape the future of health—because here, we’re redefining care for you, for us, for all. Your feedback matters. Every nurse’s voice is vital in shaping our culture and improving care. We value your insights and experiences because they help us grow stronger together. Ready to Take the Next Step: 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.