Utilization Management Clinical Nurse - Full-time, Days
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Winfield, IL 60190
The Utilization management nurse role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing the EMR and collaborating with the health care team.
Concurrent review of patient s clinical information for efficiency and correct level of care and admission status; Interface with payers concurrently and after discharge to obtain authorization; Concurrent denials management; Collaborates with the denials management team; Ongoing review of precertification requests for medical necessity; Monitor the activities of clinical and non-clinical staff; Collaborates with the health care team and payers to assist with coordinating patient s discharge planning needs; Employ effective use of knowledge, critical thinking and skills; Work in an intensive, fast-paced environment with minimal supervision; Ability to stay organized and interact well with others in any situation; Provide updates to Director of Utilization Management for review.
Bachelor s degree in Nursing; Masters preferred
State licensure as a Registered Nurse (RN)
Minimum 2 years of prior experience in Utilization Management preferred
Utilization Management or Case Management certification preferred
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability or sexual orientation.
Employer’s Job# 0061062
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