What are the responsibilities and job description for the Utilization Management RN position at UW Health in Northern Illinois?

Pay Range: $70,300.00 - $109,000.00 / year

Additional components of compensation may include:

- Evening, night, and weekend shift differential
- Overtime
- On-call pay

Benefits information: https://careers.uwhealth.org/benefits/

At UW Health in northern Illinois, you will have:

• Competitive pay and comprehensive benefits package including: PTO, Medical, Dental, Vision, retirement, short and long-term disability, paternity leave, adoption assistance, tuition assistance

• Annual wellness reimbursement

• Opportunity for on-site day care through UW Health Kids

• Tuition reimbursement for career advancement--ask about our fully funded programs!

• Abundant career growth opportunities to nurture professional development

• Strong shared governance structure

• Commitment to employee voice

POSITION SUMMARY:

The primary responsibility of the utilization management nurse is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients. An understanding of the severity of an array illnesses, intensity of service, and care coordination needs are key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. The utilization management nurse works with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process of such findings.

EDUCATION/TRAINING:

Minimum:

Bachelor of Science in Nursing.

Preferred:

N/A

LICENSURE/CERTIFICATION:

Minimum:

Current Registered Nurse licensure from the Illinois Department of Professional Registration.

Preferred:

N/A

EXPERIENCE:

Minimum:

N/A

Preferred:

Inpatient care management and / or utilization management experience.

REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES:

•	Successful completion of annual age and job specific competencies and skill validation tools.
•	Excellent interpersonal skills and ability to relate well with all levels within the organization and community.
•	Flexibility and excellent verbal, written, organizational and critical decision-making skills.
•	Ability to analyze and evaluate information from multiple sources.
•	Self-directed, assertive, and creative in problem solving and systems planning.

MAJOR RESPONSIBILITIES:

•	In conjunction with physicians, nursing staff and other healthcare professionals works to improve the quality of patient care and ensure the efficient and cost effective movement of patients through the healthcare continuum. Transitions patient to an appropriate level of care as soon as clinically indicated, seeking alternatives to avoid medically unnecessary stays.
•	Ensures completion of utilization management process for appropriate patients. Refers unresolved utilization management issues to medical staff leadership as needed.
•	Reviews clinical information to support patient status classification. Conducts concurrent reviews, monitors length of stay, and appropriate use of resources.
•	Works closely with designated patient accounting staff to research and provide the documentation necessary to successfully bill accounts appropriately, and in concert with CMS regulations, with a major focus on Medicaid, Medicare, and managed care contracts.
•	Assures medical necessity is met for each day when required and ensures completion of certification process with payers.
•	Schedules internal reviews for contracted companies. Provides documentation for all telephone interactions for approved and denied days for patient billing. Submits updates via telephone, insurance website, or fax as appropriate.
•	Uses skill in abstracting and interpreting medical information to evaluate defensible cases. This activity requires exceptional clinical skills as well as a thorough understanding of the CMS regulations.
•	Interacts and problem solves with Patient Registration, Billing, HIMS, medical providers, case management, and payers.
•	Aggregates and evaluates data to improve systems and processes of utilization management which include personal and team performance.

Our Commitment to Diversity, Equity, and Inclusion

UW Health is committed to fostering a workplace that creates belonging for everyone and is an Equal Employment Opportunity (EEO) employer. Our respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and physician brings to work each day. It is the policy of UW Health to provide equal opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Salary : $70,300 - $109,000

Apply for this job

Receive alerts for other Utilization Management RN job openings

Utilization Management RN

What are the responsibilities and job description for the Utilization Management RN position at UW Health in Northern Illinois?

What is the career path for a Utilization Management RN?

Sign up to receive alerts about other jobs with skills like those required for the Utilization Management RN.

Job openings at UW Health in Northern Illinois

Not the job you're looking for? Here are some other Utilization Management RN jobs in the Rockford, IL area that may be a better fit.

We don't have any other Utilization Management RN jobs in the Rockford, IL area right now.

AI Assistant is available now!