Utilization Review Nurse: Care Optimization & Payer Liaison

Advocate Health; Oak Brook (IL); On-site; USD 75,000 - 105,000; Full time

Job summary

Aurora Health Care in Oak Brook, IL seeks a Registered Nurse with utilization review experience to support UM activities and ensure compliance with regulatory requirements. The role collaborates with medical staff and payers to optimize patient care and admission status.

Required is a Bachelor's in Nursing and strong communication, critical thinking, and documentation skills. This full-time position involves applying clinical standards within a supportive care-management team.

Qualifications

• Bachelor's degree in Nursing required.
• 3 years of clinical nursing/UM or quality management experience preferred.
• Experience with utilization review criteria and regulatory guidelines beneficial.

Responsibilities

• Documents utilization review activity per department and medical center standards.
• Communicates effectively with the healthcare team to expedite care delivery and UM activities.
• Collaborates with managers, physicians, and treatment teams to ensure accurate status and compliance with guidelines.
• Maintains knowledge of healthcare regulations, reimbursement issues and impact on length of stay.
• Represents Aurora Health Care professionally, building relationships with community networks.

Skills

RN Experience

Utilization Review

IRR Competency

Clinical Documentation

Critical Thinking

Communication Skills

Conflict Resolution

Education

Bachelor's Degree in Nursing

Tools

Microsoft Office

Job description

Aurora Health Care in Oak Brook, IL seeks a Registered Nurse with utilization review experience to support UM activities and ensure compliance with regulatory requirements. The role collaborates with medical staff and payers to optimize patient care and admission status.

Required is a Bachelor's in Nursing and strong communication, critical thinking, and documentation skills. This full-time position involves applying clinical standards within a supportive care-management team.