Utilization Review Nurse

Memorial Home Services; Jacksonville (IL); On-site; USD 75,000 - 95,000; Full time

Job summary

Memorial Home Services is seeking an experienced RN for Utilization Review and Clinical Documentation Improvement. You will conduct concurrent and retrospective reviews of inpatient records, ensuring accurate documentation of patient acuity and appropriate utilization of services.

The role requires IL RN licensure and 3–5 years in acute care or home health care, with experience in utilization review preferred.

Qualifications

• Associates Degree in Nursing. Bachelor’s Degree in Nursing preferred.
• Evidence of continuing professional development
• Current RN licensure in the State of Illinois required
• 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
• Understanding of healthcare reimbursement mechanisms preferred
• Strong oral and written communication skills
• Adaptability to changes in health care environment with proactive problem solving attitudes
• Understanding of performance improvement, team collaboration, and conflict resolution

Responsibilities

• Provide concurrent and retrospective review of inpatient medical records to evaluate documentation and utilization of acute care services.
• Facilitate physician documentation to accurately reflect patient severity of illness and risk of mortality.
• Perform utilization review of patients to identify admission status (inpatient, observation, or other).
• Conduct continued stay review evaluating medical necessity, appropriateness and efficiency of health care services.
• Collaborate with health care team to certify level of care."

Skills

Communication skills

Adaptability

Problem solving

Team collaboration

Conflict resolution

Education

Associate degree in Nursing

Bachelor’s degree in Nursing

Job description

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.

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