Utilization Review Nurse

Silver Cross Hospital • New Lenox, IL

3d • $35 - $45 • Onsite

About The Position

Performs medical record review for severity of illness and intensity of service; liaison function with external review agencies to ensure compliance with regulations affecting financial reimbursement; identifies variance from established pathways.

Requirements

• Knowledge of clinical norms
• Excellent communication skills
• Critical thinking skills
• Organized and efficient time management skills
• Nurse, Registered (RN) licensure
• Current CPR

Nice To Haves

• BSN preferred
• 2-5 years previous Utilization Review experience preferred
• Relevant hospital nursing
• Hospital case management
• Insurance case management or utilization management experience preferred

Responsibilities

• Collects information from clinical medical record for severity of illness and intensity of service and documents such in clinical database
• Monitors all levels of care for appropriateness and communicates variance; evaluates plan of care to ensure it is based on accepted standards
• Provides information to external review organizations, documents pertinent communications
• Refers to designated physician advisor those patients not meeting criteria as well as quality of care concerns
• Maintains knowledge and incorporates current standards into practice

Benefits

• Medical, Dental and Vision plans
• Life Insurance
• Flexible Spending Account
• Other voluntary benefit plans
• PTO and Sick time
• 401(k) plan with a match
• Wellness program
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree