Title: RN-Spclst-Utilization Review
City, State: Lisle,IL
Department: Total Quality Management 002
Additional Job Details: Full-Time,Day, 40 hours,Weekly - PLEASE NOTE: Training will take place at Corporate Offices in Lisle and transition to on-site ED at Alexian Brothers Medical Center. Position requires flexibility in scheduling and required to work every other weekend.
Why Join AMITA?
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.
What You Will Do
Provides health care services regarding admissions, case management, discharge planning and utilization review.
- 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.
- 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).
- Graduate of an accredited school of nursing required Bachelor's of science in nursing preferred
- Three or more years of clinical experience required.One or more years of utilization review experience in the hospital or insurance industry preferred.
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.