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KANKAKEE, Illinois
Source: Riverside Healthcare careers · View original posting
From Riverside Healthcare's posting. “We” and “our” refer to the employer.
Overview
Riverside Healthcare is seeking a dedicated and experienced Utilization Review Nurse to join our Emergency Department team in Kankakee, Illinois. The Utilization Review Nurse will play a crucial role in ensuring that patients receive appropriate and effective care while optimizing resource utilization.
This position involves reviewing patient cases, assessing the necessity of admissions and continued stays, and collaborating with healthcare providers to enhance patient outcomes and hospital efficiency by managing documentation and optimizing resource utilization.
Essential Duties
Conduct thorough reviews of patient cases in the Emergency Department to assess the necessity and appropriateness of admissions, continued stays, and level of care.
Utilize clinical knowledge and evidence-based guidelines to make determinations regarding the medical necessity of services.
Work closely with physicians, nurses, and other healthcare professionals to gather necessary information and discuss care plans.
Communicate with insurance providers to obtain authorization for treatments and services, ensuring compliance with payer requirements.
Proactively facilitates throughput of all patients by monitoring for census peaks including surgical and procedural patient placement.
Maintain accurate and detailed documentation of case reviews, decisions, and communications with healthcare providers and insurance companies.
Prepare and submit reports as required, including utilization review reports and compliance documentation.
Participate in quality improvement initiatives to enhance the efficiency and effectiveness of care provided in the Emergency Department.
Analyze utilization patterns and outcomes to identify opportunities for improvement and contribute to the development of best practices.
Ensure adherence to hospital policies, payer guidelines, and regulatory requirements related to utilization management.
Stay informed about changes in healthcare regulations and payer requirements to ensure ongoing compliance.
These are duties that MUST be performed in this job, with or without reasonable accommodation.
Non-essential Duties
Assist with training and orientation of new staff members on utilization review processes and procedures.
Support administrative tasks related to the utilization review process as needed.
Participate in departmental meetings and contribute to discussions on process improvements and policy updates.
Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:
Compensation
Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed for presentations, training, telephone communication, facilitating meetings.
Vision: Needed for computer entry, reading memos and literature.
Smell: Needed for electrical/fire safety.
Hearing: Needed for telephone communication, meetings and listening to employee concerns.
Touch: Needed for writing, computer entry, filing.
Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to:
Sit: 50%
Twist: 0%
Stand: 35%
Crawl: 0%
Walk: 10%
Kneel: 0%
Lift: 5%
Drive: 0%
Squat: 0%
Climb: 0%
Bend: 0%
Reach above shoulders: 0%
The weight required to be lifted each normal workday according to the continuum described below:
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
Brief case, notebook, computer, printed material-transported from one location/meeting to another.
Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 480
Twist: 0
Stand: 240
Crawl: 0
Walk: 60
Kneel: 0
Lift: 5
Drive: 0
Squat: 0
Climb: 0
Bend: 0
Reach above shoulders: 0
Simple grasp up to 10 lbs. Normal weight:
Special Hazards: None
Protective Clothing Required: None
Pay Range
USD $41.31 - USD $55.28 /Hr
Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:
Compensation
Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed for presentations, training, telephone communication, facilitating meetings.
Vision: Needed for computer entry, reading memos and literature.
Smell: Needed for electrical/fire safety.
Hearing: Needed for telephone communication, meetings and listening to employee concerns.
Touch: Needed for writing, computer entry, filing.
Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to:
Sit: 50%
Twist: 0%
Stand: 35%
Crawl: 0%
Walk: 10%
Kneel: 0%
Lift: 5%
Drive: 0%
Squat: 0%
Climb: 0%
Bend: 0%
Reach above shoulders: 0%
The weight required to be lifted each normal workday according to the continuum described below:
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
Brief case, notebook, computer, printed material-transported from one location/meeting to another.
Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 480
Twist: 0
Stand: 240
Crawl: 0
Walk: 60
Kneel: 0
Lift: 5
Drive: 0
Squat: 0
Climb: 0
Bend: 0
Reach above shoulders: 0
Simple grasp up to 10 lbs. Normal weight:
Special Hazards: None
Protective Clothing Required: None
LAYIQ is an independent job-discovery service. This listing does not imply a partnership with or endorsement by the employer. Review the original posting for current details and availability.
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