Quality Utilization Nurse - Onsite to Hybrid

Northwestern Memorial Healthcare; Illinois; Hybrid; USD 85,000 - 100,000; Full time

Benefits offered by this job

Tuition reimbursement

Loan forgiveness

401(k) matching

Lifecycle benefits

Job summary

Northwestern Medicine is seeking a Quality Utilization Specialist (RN) to review admissions and length of stay, collaborate with clinicians, and guide utilization decisions. You will work with a multidisciplinary team to ensure appropriate care levels, medical necessity, and payer communications.

Strong leadership, analytical abilities, and familiarity with utilization metrics are essential. The role emphasizes performance improvement, education programs, and adherence to regulatory guidelines,

Qualifications

• Licensed Registered Nurse in Illinois (IDFPR).
• Bachelor’s Degree in Nursing.
• 5 years of experience in acute inpatient hospital care.
• Proven leadership and diplomacy skills.
• Organizational, team building, coaching, and conflict management.
• Analytical skills to collect, analyze, and interpret data.
• Computer skills including word processing and spreadsheets.

Responsibilities

• Applies clinical criteria to ensure appropriate admission and length of stay.
• Completes admission and continuing stay reviews for hospitalized patients.
• Collaborates with Payor Specialists to communicate clinical information.
• Partners with leadership to identify utilization processes for right care.
• Monitors data elements related to Utilization through reporting tools.
• Participates in performance improvement initiatives and education programs.
• Assists in recovery audit processes and appeals as needed.
• Maintains knowledge of federal and state utilization laws.

Skills

Leadership

Diplomacy

Analytical skills

Organizational skills

Coaching

Conflict management

Communication

Education

Bachelor’s Degree in Nursing

Tools

Word processing

Spreadsheets

Job description

Northwestern Medicine is seeking a Quality Utilization Specialist (RN) to review admissions and length of stay, collaborate with clinicians, and guide utilization decisions. You will work with a multidisciplinary team to ensure appropriate care levels, medical necessity, and payer communications.

Strong leadership, analytical abilities, and familiarity with utilization metrics are essential. The role emphasizes performance improvement, education programs, and adherence to regulatory guidelines,