Utilization Mgmt. RN Care Coordination Full Time Evenings

Northwestern Medicine; Winfield (IL); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Tuition reimbursement

401(k) matching

Loan forgiveness

Job summary

Northwestern Medicine is seeking a Utilization Management RN located in Winfield, Illinois. The position involves reviewing patient clinical information, collaborating with healthcare providers, and managing denials. A Bachelor's degree in Nursing and RN licensure are required with preference for those holding a Master's degree and relevant experience. Competitive benefits and a sign-on bonus may be available. Join us as we strive to provide the best care in healthcare.

Qualifications

• State licensure as a Registered Nurse (RN) is required.
• Minimum 2 years of experience in Utilization Management is preferred.
• Utilization Management or Case Management certification is a plus.

Responsibilities

• Review clinical information for efficiency and correct level of care.
• Interface with payers to obtain authorization.
• Collaborate with healthcare team members.

Skills

Critical thinking

Organizational skills

Collaboration

Education

Bachelor's degree in Nursing

Master's degree

Job description

Overview

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 health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees.

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.

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

Additional Information

Northwestern Medicine is an equal opportunity employer (disability, VETS) 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.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility

Note: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.