Registered Nurse Utilization Review

Hourly Pay Range $38.16 - $59.15. The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. Position Highlights Position: RN Utilization Review Location: Naperville, IL Full Time: 40 hours/week Hours: Monday-Friday, 8:00 a.m. - 4:30 p.m., rotating every 6-8 weekend Required Travel: Between Edward-Elmhurst-Corporate locations A Brief Overview Under minimal supervision and using clinical knowledge, the RN Utilization Review completes utilization review activities to ensure appropriateness of admission and continued stay and to reduce financial risk to the patient and hospital. Works on complex reviews. Communicates results of reviews to payers and other third parties for certification of hospitalization and subsequent payment. Acts as a clinical resource for the Coordinator Utilization Review. What you will do Perform concurrent clinical reviews for utilization review using appropriate screening criteria; complete necessary review as identified and required by payers until patient discharge. Reviews must be thorough and completed on a timely basis. Communicate with team members including physicians, case managers, social workers, Utilization Review Coordinators, and nurses regarding utilization issues. Perform continual tracking of in‑house patient status; communicate with appropriate team members and third parties regarding status issues. Track denials and report the issues through the appropriator channels; follow through with Coordinator Clinical Denials to appeal appropriate denials. Perform continual review of in‑house observation patients. Communicate with case management regarding patient status and issues. Identify and track avoidable days. Refer case to physician advisor as necessary. When appropriate, obtain orders for status changes from physicians and document the order in the electronic medical record. Act as a clinical resource for Coordinator Utilization Review. What you will need Associate Degree in Nursing (required) Bachelor’s Degree in Nursing (preferred) 2 Years of utilization review and/or clinical experience 2 Years of utilization review experience Registered Nurse (RN) licensed by Illinois Department of Financial and Professional Regulation (IDFPR) (required) Benefits (for full and part‑time positions) Premium pay for eligible positions Career Pathways to Promote Professional Growth and Development Various Medical, Dental, and Vision options Tuition Reimbursement Free Parking at designated locations Wellness Program Savings Plan Health Savings Account Options Retirement Options with Company Match Paid Time Off Community Involvement Opportunities Equal Opportunity Employer EOE: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor. #J-18808-Ljbffr