- Bachelors degree is preferred
- Licensure Required
- Experience is preferred
RN (BSN preferred) with current Illinois license; 3-5 years clinical experience; basic computer word processing knowledge and proficiency; prior experience in Utilization Review or Quality Assurance is desirable; working knowledge of Medicare reimbursement & coding structures.
Job: Coordinates the care/service of selected patients to promote effective utilization of health care resources & interacts with the interdisciplinary team for achievement of optimal clinical & resource outcomes. Concurrently reviews the medical record & queries medical staff & other caregivers as necessary to obtain accurate and complete documentation that supports the patient’s severity of illness. Screens patient records for appropriate utilization of medical services & quality medical management. Provides information to third-party payers and/or regulatory agencies as requested to meet provider guidelines for reimbursement. Assists with patient discharge planning including screening for post-discharge needs & assisting with Home Health, DME, & other services needed to facilitate a safe & timely discharge.
St. Elizabeth's Hospital - 4 months ago