The Registered Nurse Utilization Review Coordinator provides professional assessment, coordination, and utilization review in accordance with all state mandated regulations. Functions as an advocate and contact person for the patient with the insurance company and outside agencies to assure continuity of care and optimal clinical and resource outcomes.
- Analyzes patient electronic records, and participates in interdisciplinary collaboration with professional staff within designated timeframes to determine suitability of the level of care in accordance with approved Intensity of Service and Severity of Illness ( IS/SI) and/ or other established criteria.
- Performs continuing review on patients’ medical records to ensure appropriate cost efficient healthcare services to patients and their need of on-going hospitalization
- Conduct reviews and validates physician’s orders, medical reports and communicates the progress and unusual occurrences on patients to UR Supervisor and/or Hospitalist/Attending Physician.
- Documents utilization review information in appropriate computer system and communicates results with claim adjusters.
- Enters billing information for services.
- Receives and processes requests for appeal of denials.
- Maintains Utility review and appeal logs as needed.
- Advises physicians and other departments of regulations affecting utilization management.
- Consults with the Care Management nurses regarding the discharge plans.
Please be advised that we are only considering nurses with the following
Must by a licensed RN in the state of Illinois
Must have 5 + years of clinical experience
Must have previous experience with inpatient utilization review
Must have experience using Milliman guidelines and electronic medical records
Comprehensive benefits for temporary employees include:
- Life Insurance/Disability
Pathway Medical Staffing - 18 months ago
Since 1998 Pathway Medical Staffing has placed case managers and non-bedside nurses in great jobs at hundreds of leading healthcare...