Utilization Review Nurse

Memorial Health; Jacksonville (IL); On-site; USD 48,000 - 79,000; Full time

Benefits offered by this job

Paid time off

401(k) match

Health insurance

Job summary

Memorial Health in Illinois is seeking a Registered Nurse to join our Utilization Review and Clinical Documentation Improvement team. Under supervision, you will perform concurrent and retrospective reviews of inpatient records to ensure accurate documentation and appropriate utilization of acute care services.

The role requires 3–5 years of acute care or case management experience, an Illinois RN license, and an Associates degree (Bachelor’s preferred).

Qualifications

• Associates degree in nursing; Bachelor’s preferred.
• Current RN licensure in Illinois required.
• Minimum 3–5 years acute care and/or case management experience.

Responsibilities

• Perform concurrent and retrospective reviews of inpatient records.
• Ensure documentation reflects severity of illness and risk of mortality.
• Collaborate with care teams to determine appropriate level of care (inpatient/observation).
• Identify patients for admission status and discharge planning.

Skills

Utilization review

Nursing leadership

Clinical documentation

Education

Associate degree in nursing

Bachelor’s degree preferred

Tools

Electronic Health Records (EHR)

Job description

Focused on the Future of Care We're looking for talented, passionate healthcare professionals to join the team at Memorial Health as we build the future of healthcare. If you're ready to be part of a transformative organization that puts people first, take a look at what we have to offer.

Position Type

On-site

Job Description Summary

Under the direct supervision of the Supervisor, Utilization Review and Clinical Documentation Improvement, this role will be responsible for providing clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation and utilization of acute care services. This includes facilitation of appropriate physician documentation of care to accurately reflect patient severity of illness and risk of mortality. Additionally, this role will be responsible for performing utilization review of all patients presenting for hospitalization to assist in identifying patients appropriate for admission to inpatient, observation, or other patient care status. This position conducts continued stay review evaluating the medical necessity, appropriateness and efficient use of health care services of all hospitalizations (inpatient & outpatient). This role will collaborate with the health care team to optimally certify the level of care.

Job Description

Schedule: 0900-2100, every third weekend.

72 Hour Per Pay Period

Education: Associates Degree in Nursing. Bachelor’s Degree in Nursing preferred. Evidence of continuing professional development

Licensure/Certification/Registry: Current RN licensure in the State of Illinois required

Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review experience strongly preferred.

Other Knowledge/Skills/Abilities: Understanding of healthcare reimbursement mechanisms preferred. Strong oral and written communication skills. Demonstrated adaptability to changes in health care environment with proactive problem solving attitudes Understanding of the principles of performance improvement, team collaboration, and conflict resolution

Pay Transparency

$35.92 - $57.47 Additional compensation in the form(s) of participation in our annual incentive program are dependent on role. Pay is based on factors such as work experience, education, certification(s), training, skills, and competencies related to the role.

Benefits

Memorial Health also offers a comprehensive benefits plan, which includes paid time off, 401(k) match, and health/ dental/ vision insurance options.

All benefits can be found at https://jobs.memorial.health/about/benefits/

Accommodation

If you require a reasonable accommodation to complete this application or participate in the hiring process, please contact [e-mail]. Requests will be handled confidentially.

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