ER Utilization Review Nurse: Optimize Care & Throughput

Riverside Healthcare

Kankakee (IL)

On-site

USD 57,000 - 76,000

Full time

4 days ago

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Benefits offered by this job

Health benefits

Educational assistance

Retirement plan

Paid time off

Job summary

Riverside Healthcare in Kankakee, IL is seeking an experienced Utilization Review Nurse to join the Emergency Department. You will review patient cases, assess admissions necessity, and collaborate with physicians to optimize care and hospital efficiency.

The ideal candidate has a current Illinois RN license, an ADN (BSN encouraged) and at least 3 years of ED experience, with strong clinical assessment, communication, and knowledge of utilization review processes and EHR systems.

Qualifications

3+ years of clinical experience in an Emergency Department setting.
Active RN license in Illinois.
ADN required; BSN encouraged; 1/1/25 or later graduates must complete BSN within 3 years.

Responsibilities

Review patient cases in the ED to assess admissions necessity, level of care, and continued stays.
Collaborate with physicians and nurses to gather information and discuss care plans.
Communicate with insurance providers to obtain authorizations and ensure payer compliance.
Maintain detailed documentation of reviews and communications; prepare reports as required.
Participate in quality improvement initiatives and monitor utilization patterns for improvement opportunities.