What are the responsibilities and job description for the Utilization Review RN position at Memorial Health?
USD $32.95/Hr.
Max
USD $52.73/Hr.
Overview
Schedule: 7:30-4:00
Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services.
This is not a remote position.
Education
Qualifications
Associates Degree in Nursing. Bachelor’s Degree in Nursing preferred.
Evidence of continuing professional development
Licensure/Certification/Registry
Current RN licensure in the State of Illinois required
Experience
Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review experience strongly preferred.
Other Knowledge/Skills/Abilities
Understanding of healthcare reimbursement mechanisms preferred.
Strong oral and written communication skills.
Demonstrated adaptability to changes in health care environment with proactive problem solving attitudes
Understanding of the principles of performance improvement, team collaboration, and conflict resolution
Max
USD $52.73/Hr.
Overview
Schedule: 7:30-4:00
Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services.
This is not a remote position.
Education
Qualifications
Associates Degree in Nursing. Bachelor’s Degree in Nursing preferred.
Evidence of continuing professional development
Licensure/Certification/Registry
Current RN licensure in the State of Illinois required
Experience
Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review experience strongly preferred.
Other Knowledge/Skills/Abilities
Understanding of healthcare reimbursement mechanisms preferred.
Strong oral and written communication skills.
Demonstrated adaptability to changes in health care environment with proactive problem solving attitudes
Understanding of the principles of performance improvement, team collaboration, and conflict resolution
Salary : $33 - $53
