USD $32.95/Hr.
USD $52.73/Hr.
Shift: 12pm - 12am or 8:00-4:30pm
Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates physician documentation through concurrent interaction with physicians to support reimbursement and clinical severity is captured for the service rendered to patients receiving hospital care. Provides clinical knowledge and data collection for quality improvement initiatives. Optimizes reimbursement for acute care services.
This is NOT a remote position.
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
Memorial Health is one of the leading healthcare organizations in Illinois—a responsibility we are proud to uphold. Founded in 1897 to meet the expanding needs of our communities, we have assembled an ever-growing team and vast resources.
Dedicated to unsurpassed excellence in care, education, and research, our community-based, not-for-profit corporation features a team of nearly 10,000 strong throughout eight state-of-the-art affiliates offering a broad array of vital services. Yet what matters equally is the size of our heart. Our ambitions. And our potential to do bigger and better things.
We’re achieving our goals by developing academic alliances with other respected institutions, including the BJC HealthCare Collaborative and the Southern Illinois University School of Medicine. By earning important credentials and accreditations. By making a real investment in employee development. And by building upon our reputation for excellence on the regional level, with the goal of realizing national prominence.
