What are the responsibilities and job description for the Registered Nurse Utilization Review-Days position at NorthShore University HealthSystem?
Hourly Pay Range:
$38.16 - $59.15 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.Position Highlights:
- Position: RN Utilization Review
- Location: Naperville, IL
- Full Time/Part Time: full time, 40 hours
- Hours: Monday-Friday, 8:00a-4:30p, with rotating weekends and holidays
A Brief Overview:
Under minimal supervision and using clinical knowledge, the RN Utilization Review completes utilization review activities to ensure appropriateness of admission and continued stay and to reduce financial risk to the patient and hospital. Works on complex reviews. Communicates results of reviews to payers and other third parties for certification of hospitalization and subsequent payment. Acts as a clinical resource for the Coordinator Utilization Review.
What you will do:
- Performs concurrent clinical reviews for utilization review using appropriate screening criteria; completes necessary review as identified and required by payers until patient discharge. Reviews must be thorough and completed on a timely basis.
- Communicates with team members including physicians, case managers, social workers, Utilization Review Coordinators, and nurses, regarding utilization issues.
- Performs continual tracking of in-house patient status; communicates with appropriate team members and third parties regarding status issues.
- Tracks denials and reports the issues through the appropriator channels; follows through with Coordinator Clinical Denials to appeal appropriate denials.
- Performs continual review of in-house observation patients. Communicates with case management regarding patient status and issues.
- Identifies and tracks Avoidable Days. Refers case to physician advisor as necessary.
- When appropriate obtains orders for status changes from physicians and documents the order in the electronic medical record.
- Acts as a clinical resource for Coordinator Utilization Review.
What you will need:
- Associates Degree Nursing Required
- Bachelors Degree Nursing Preferred
- 2 Years of utilization review and/or clinical experience And
- 2 Years of utilization review experience
- Registered Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) Required
Benefits (for full and part time positions):
- Premium pay for eligible employees
- Career Pathways to Promote Professional Growth and Development
- Various Medical, Dental, and Vision options
- Tuition Reimbursement
- Free Parking at designated locations
- Wellness Program Savings Plan
- Health Savings Account Options
- Retirement Options with Company Match
- Paid Time Off
- Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.
When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.
Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".
Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.
Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
Salary : $38 - $59