Utilization Review Nurse

About This Role

This nursing role focuses on the clinical review of inpatient medical records to assess documentation and the use of acute care services. It involves ensuring accurate physician documentation of patient severity and risk, as well as performing utilization review for hospital admissions to determine appropriate patient care status. The nurse will also conduct continued stay reviews to evaluate medical necessity and efficient use of healthcare services, collaborating with the healthcare team to certify the level of care.

Responsibilities

• Provide clinically based concurrent and retrospective review of inpatient medical records to evaluate documentation and utilization of acute care services
• Facilitate appropriate physician documentation of care to accurately reflect patient severity of illness and risk of mortality
• Perform utilization review of all patients presenting for hospitalization to assist in identifying patients appropriate for admission to inpatient, observation, or other patient care status
• Conduct continued stay review evaluating the medical necessity, appropriateness and efficient use of health care services of all hospitalizations (inpatient & outpatient)
• Collaborate with the health care team to optimally certify the level of care

Requirements

• Associate's Degree in Nursing
• Evidence of continuing professional development
• Current RN licensure in the State of Illinois
• Minimum of 3-5 years of recent acute care and/or home health nursing or case management experience
• 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

Nice to have:

• Bachelor's Degree in Nursing
• Previous utilization review experience
• Understanding of healthcare reimbursement mechanisms

Benefits

• Paid Time Off (PTO)
• Memorial Childcare
• Mental Health Services
• Growth Opportunities
• Continuing Education
• Local and National Discounts
• Pet Insurance
• Medical, Dental, Vision
• Flexible Spending Account
• 401(k)
• Life Insurance and Voluntary Benefits
• Employee Assistance Program and Colleague Wellness
• Adoption Assistance

Important Details

• Schedule: 09:00-21:00, every third weekend
• Hours: 72 hours per pay period