Utilization Review Nurse

Rising Medical Solutions, LLC; Chicago (IL); Sur place; USD 65 000 - 90 000; Plein temps

Avantages offerts par ce poste

Flexible time off

Health insurance

Dental insurance

Vision insurance

Profit sharing

401k matching

Career growth opportunities

Professional Development Reimbursement

Elevate program

Top Workplace 2023

Culture videos on YouTube

Facebook/LinkedIn presence

Résumé du poste

Rising Medical Solutions in Chicago, IL is seeking a Utilization Review Nurse for a full-time position. You will perform UR processes, review records through various channels, and apply evidence-based guidelines to determine authorizations.

You will write nurse summaries and document decisions in our systems. The ideal candidate holds an RN license, a nursing degree, 3–5 years clinical or 2 years UR/case management, and strong analytical and communication skills.

Qualifications

• Associate's or Bachelor's degree in Nursing.
• Active RN license in one or more states.
• 3–5 years of clinical nursing practice or 2 years in case management or UR.
• Experience with Workers' Compensation, disability, or liability claims.
• Ability to work autonomously and in a team.
• Strong time-management and organizational skills.
• Proficient with CPT, ICD-9/ICD-10, and Medicare guidelines.
• Proficient with MS Word, Excel, and Outlook.

Responsabilités

• Perform all aspects of the Utilization Review process.
• Review UR requests via mail, email, fax, or phone.
• Apply evidence-based guidelines to authorize or refer files.
• Write nurse summaries for UR files.
• Document in Rising's databases and send determinations.
• Establish collaborative relationships with clients, patients, employers, providers and attorneys.
• Track ongoing status of UR activity to meet turnaround times.
• Maintain organized files with clinical documentation.
• Utilize good clinical judgment, listening, and critical thinking.
• Respond to inquiries regarding status of cases.
• Proficient use of multiple software programs.

Connaissances

Clinical experience

Communication

Analytical skills

Time management

Team collaboration

MS Word/Excel/Outlook

Formation

Associate's or Bachelor's degree in Nursing

Outils

Microsoft Word

Excel

Outlook

Description du poste

Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!

**This is a full-time position - 40 hours per week (Must work M-F each day).**

Responsibilities

• Perform all aspects of the Utilization Review Process
• Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
• Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review
• Write nurse summaries on all UR files
• Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR
• Establish collaborative relationships with clients, patients, employers, providers and attorneys
• Track ongoing status of all UR activity so that appropriate turn-around times are met
• Maintain organized files containing clinical documentation of interactions with all parties of every claim
• Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
• Respond to various written and telephonic inquiries regarding status of case
• Must be proficient in the use of a computer, including the use of various software programs simultaneously

• An Associate's or Bachelor's degree in Nursing
• Hold an active and unencumbered RN license in one or more states
• 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
• More than one state license (a plus)
• Experience with Workers' Compensation, short-term or long-term disability, or liability claims
• The ability to set priorities and work both autonomously and as a team member
• Well-developed time-management, organization, and prioritization skills
• Excellent analytical skills
• Superb oral and written communication
• The ability to gather data, compile information, and prepare summary reports
• Strong interpersonal and conflict resolution skills
• Experience in a fast-paced, multi-faceted environment
• Demonstrated persistence and attention to detail
• General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
• Working knowledge of: Microsoft Word, Excel, and Outlook
• Ability to remain calm during stressful situations
• A customer-service mindset

• Generous Flexible Time Off (take it when you need it!)
• Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
• Career Growth Opportunities - We often promote from within
• Professional Development Reimbursement Program (PDRP)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work
• Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions | Top Workplaces
• We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical
• Want to see more? Check out our:
  • Facebook: https://www.facebook.com/RisingMedicalSolutions
  • LinkedIn: http://www.linkedin.com/company/rising-medical-sol..