Registered Nurse - Utilization Review
Exempt | Full-Time
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.
AMITA Health is the largest health system in Illinois, comprising 19 hospitals and more than 230 sites of care. The health system has 900 providers in its medical groups, more than 26,000 associates and 7,000 physician partners and serves over 4.3 million residents in the greater Chicagoland area.
What You Will Do
As an Associate with AMITA Health, you will have the opportunity to
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.
- May prepare statistical analysis and utilization review reports as necessary.
- Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.
What You Will Need
- Required Credential(s):
- Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date or job transfer date.
- Diploma from an accredited school/college of nursing required.
- BSN strong preferred.
- At least 2-3 years of case management and/or discharge planning strongly 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.