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Clinical Nurse - CDH Utilization Management, Full-times, Days

Location Winfield, Illinois Business Unit Central DuPage Hospital Job REQID 14605 Job Function Nursing Coordinator Shift Evening Job (2nd) Apply Now

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Description

The Utilization Management RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

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.

This position is 12hr shifts(10am-10:30pm) in the Emergency Department.

Responsibilities:

  • Concurrent review of patients 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 pre-certification 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 patients 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

Qualifications

Required:

  • Bachelor's degree in Nursing
  • State licensure as a Registered Nurse (RN)

Preferred:

  • Master's degree
  • Minimum 2 years of prior experience in Utilization Management
  • Utilization Management or Case Management certification

Equal Opportunity

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, sexual orientation or any other protected status.

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