Utilization Review Nurse

Focused on the Future of Care

We're looking for talented, passionate healthcare professionals to join the team at Memorial Health as we build the future of healthcare. If you're ready to be part of a transformative organization that puts people first, take a look at what we have to offer.

Position Type:

On-site

Job Description Summary:

Under the direct supervision of the Supervisor, Utilization Review and Clinical Documentation Improvement, this role will be responsible for providing clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation and utilization of acute care services. This includes facilitation of appropriate physician documentation of care to accurately reflect patient severity of illness and risk of mortality. Additionally, this role will be responsible for performing utilization review of all patients presenting for hospitalization to assist in identifying patients appropriate for admission to inpatient, observation, or other patient care status. This position conducts continued stay review evaluating the medical necessity, appropriateness and efficient use of health care services of all hospitalizations (inpatient & outpatient). This role will collaborate with the health care team to optimally certify the level of care.

Job Description:

Schedule: 0900-2100, every third weekend.

72 Hour Per Pay Period

Education:

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

Pay Transparency

$35.92 - $57.47

Additional compensation in the form(s) of participation in our annual incentive program are dependent on role. Pay is based on factors such as work experience, education, certification(s), training, skills, and competencies related to the role. Memorial Health also offers a comprehensive benefits plan, which includes paid time off, 401(k) match, and health/ dental/ vision insurance options. All benefits can be found at https://jobs.memorial.health/about/benefits/

If you require a reasonable accommodation to complete this application or participate in the hiring process, please contact [email protected]. Requests will be handled confidentially.