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Registered Nurse Utilization Review Specialist - SAMC

Additional Job Information

Title: RN-Spclst-Utilization Review

City, State: Lisle,IL

Location: Navistar

Department: Total Quality Management 002

Additional Job Details: Full-Time,Day, 40 hours,Weekly - PLEASE NOTE: Training will place at Corporate Offices in Lisle and transition to on-site ED at Saint Alexius Medical Center. Position requires flexibility in scheduling and required to work every other weekend.

About Us

AMITA Health (www.AMITAhealth.org) is a joint operating company formed by the Adventist Health System in Altamonte Springs, FL and St. Louis, MO based Ascension.

With the addition of Presence Health, AMITA Health is now the largest health system in Illinois, comprising 19 hospitals and more than 230 sites of care. The newly combined health system has 900 providers in its medical groups, more than 26,000 associates and 7,000 physician partners and now serves over 4.3 million residents in the greater Chicagoland area.

Job Description

Job Summary:

Provides health care services regarding admissions, case management, discharge planning and utilization review.

Responsibilities:
  • Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.
  • Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assesses and coordinates discharge planning needs with healthcare team members.
  • Prepares statistical analysis and utilization review reports as necessary.

Qualifications


Licenses/Certifications/Registration:
  • Required Credential(s):
    • Licensed Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date or job transfer date.
  • Preferred Credential(s):
    • Certified Case Manager credentialed from the American Case Management Association (ACMA).
    • Certified Case Manager credentialed from the Commission for Case Manager Certification (CCMC).
    • Certification specializing in Utilization Review credentialed from the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP).

Education:
  • Diploma
    • Graduate of an accredited school of nursing required Bachelor's of science in nursing preferred

Work Experience:
  • Three or more years of clinical experience required.One or more years of utilization review experience in the hospital or insurance industry preferred.

How To Apply

We urge you to apply to any/all positions that you have interest in. If you fit the qualifications for the role, we will reach out to you. Please ensure you complete all required fields within the application (indicated with an asterisk), as well as additional information that is requested of you. Information that you offer us will better assist us in understanding your qualifications and fit for the position(s) you've applied for.

Equal Employment Opportunity

AMITA Health will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.
AMITA Health 
Location: LisleIL 60532
Document ID: AC272-1PYI  
Job Type:  Regular

Job Schedule: Full-time


Posted on: 2018-09-2009/20/2018
2018-10-20
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