Top 36 Utilization review nurse Jobs in Hoffman Estates, Il

Utilization Management Nurse
Advocate Aurora Health —Oak Brook, IL
- $35.50 - $53.25 an hour
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
4d
Utilization Review/Reimbursement Specialist
Sinai Chicago —Chicago, IL
- Full-time
- Nursing
- Hospital
- Customer service
- Health savings account
- AD&D insurance
Quick Apply
Utilization Management Specialist
Gateway Foundation Inc —Chicago, IL
- $51,463 - $60,000 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- Office
- Wellness program
- Continuing education credits
Quick Apply
Registered Nurse (RN) –Patient Command Center Night Shift 0.9
Advocate Aurora Health —Oakbrook Terrace, IL
- $38.20 - $57.30 an hour
- Full-time
- CPR Certification
- Nursing
- Surgery
6h
Post Acute Nurse Manager
Avondale Estates of Elgin —Elgin, IL
- $94,764.26 - $101,012.24 a year
- Full-time
- Patient monitoring
- Outpatient experience
- Medical-surgical
- Disability insurance
- Health insurance
Quick Apply
8d
RN Care Manager
Advocate Aurora Health —Downers Grove, IL
- $38.20 - $57.30 an hour
- Full-time
- Nursing
- RN License
- Hospital
8d
Clinical Documentation Specialist
Community First Medical Center —Chicago, IL
- $70,000 - $85,000 a year
- Full-time
- Microsoft Word
- Nursing
- Medicine
- Free parking
- Continuing education credits
Quick Apply
Utilization Management and Population Health Nurse
Humboldt Park Health —Chicago, IL
- Nursing
- RN License
- Mid-level
Quick Apply
10d
Inpatient RN Care Manager
Advocate Aurora Health —Park Ridge, IL
- $38.20 - $57.30 an hour
- Full-time
- Acute care
- Nursing
- RN License
Registered Nurse Clinical Manager
Centerwell —Schaumburg, IL
- $84,900 - $116,800 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
RN MDS Coordinator - Chicagoland Area
Jade Financial Service LLC —Skokie, IL
- From $80,000 a year
- Full-time
- Hybrid work
- CPR Certification
- Nursing
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
6h
Home Health Registered Nurse
home care services —Cook County, IL
- $70 - $90 an hour
- Part-time
- Vital signs
- RN License
- HIPAA
Quick Apply
1d
Home Health Registered Nurse
North Western Home Health Care —Hoffman Estates, IL
- $60 - $80 an hour
- Part-time
- HIPAA
- Mid-level
- Outpatient experience
Quick Apply
RN Care Manager-Nights
Endeavor Health —Glenview, IL
- $40.45 - $62.70 an hour
- Part-time
- Acute care
- Nursing
- BLS Certification
- Free parking
- Wellness program
Bilingual Medical Case Manager II
CorVel Corporation —Downers Grove, IL
- $65,436 - $98,982 a year
- Full-time
- Remote
- Bilingual
- Nursing
- RN License
- Health savings account
- Disability insurance
Quick Apply
Home visiting Home Health Registered Nurse
North Western Home Health Care —Hoffman Estates, IL
- $60 - $85 an hour
- Part-time
- Vital signs
- HIPAA
- Mid-level
- Flexible schedule
Quick Apply
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —Lombard, IL
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
MDS Coordinator
Nivram Management —Lincolnwood, IL
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Disability insurance
Quick Apply
Behavioral Health Care Coordinator
viva —Chicago, IL
- $17 - $22 an hour
- Full-time
- RN License
- Mid-level
- 3 years
4d

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utilization review nurse jobs near hoffman estates, il

Utilization Management Nurse

Advocate Aurora Health -
Oak Brook, IL

Apply Now

Job Details

Full-time
$35.50 - $53.25 an hour
4 days ago

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
Utilization review
RN License
Word embeddings
Employee relationship building
Utilization management
Conflict management
Patient interaction
Acute care experience

Full Job Description

Major Responsibilities:

Documents utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria.
Communicates effectively with the healthcare team. Works closely with medical staff, hospital departments and ancillary services as part of Outcome Facilitation Team/Multidisciplinary Team in expediting care delivery to avoid delays in timely service provision and implementing and reporting utilization management (UM) activities, as applicable.
Collaborates with managers, physicians, medical directors, advisory groups and treatment teams for issues related to physician practices and best practices for the patient’s plan of care. Refers cases to physician advisor as needed to ensure accurate status and compliance with regulatory guidelines.
Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Provides clinical updates to payers and/or external review organizations, collects data, coordinates denial activity, supports UM activity, and manages avoidable delays.
Develops and maintains productive relationships with community-based agencies and networks by representing Aurora Health Care in a positive manner working collaboratively, internally and externally, to meet patient/family needs.
Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, and relevant regulatory requirements.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Licensure, Registration, and/or Certification Required:

Registered Nurse license issued by the state in which the team member practices.

Education Required:

Bachelor's Degree (or equivalent knowledge) in Nursing.

Experience Required:

Typically requires 3 years of experience in clinical nursing, utilization and/or quality management.

Knowledge, Skills & Abilities Required:

Must have working knowledge in the use of Microsoft Office (Excel, Outlook, PowerPoint and Word) or similar products.
Knowledge of the components of quality and acute care patient care needs specifically related to the area/function in which care management will be performed.
Demonstrates working knowledge of Utilization Review criteria as demonstrated by achieving 80% or greater on the annual InterRater Reliability (IRR) competency exam.
Utilizes critical thinking skills to analyze and synthesize clinical scenarios as it relates to application of medical necessity criteria.
Excellent analytical and interpersonal communication skills necessary to interact with families, patients, physicians, and third party payers.
Ability to manage conflict appropriately, seeking a win-win outcome by communicating issues in accordance with the Aurora Service commitments.
Promotes effective professional relationships with physicians and other professionals in a direct and positive manner.
Takes responsibility self-development by seeking out opportunities for professional growth and development and being an active participant in department, hospital, and system initiatives.

Physical Requirements and Working Conditions:

Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
Must lift up to 10lbs. continuously and up to 20 lbs. frequently.
Manual dexterity required for operation computer and calculator.
Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.
Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
Exposed to normal office environment; including usual hazards related to operating electrical equipment.
Operates all equipment necessary to perform the job.
May be exposed to mechanical, electrical, chemical, and radiation hazards as well as blood and body fluids; therefore, personal protective equipment must be worn as necessary.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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Refine Your Search

utilization review nurse jobs in hoffman estates, il

Utilization Management Nurse

Utilization Review/Reimbursement Specialist

Utilization Management Specialist

Registered Nurse (RN) –Patient Command Center Night Shift 0.9

Post Acute Nurse Manager

RN Care Manager

Clinical Documentation Specialist

Utilization Management and Population Health Nurse

Inpatient RN Care Manager

Registered Nurse Clinical Manager

RN MDS Coordinator - Chicagoland Area

Home Health Registered Nurse

Home Health Registered Nurse

RN Care Manager-Nights

Bilingual Medical Case Manager II

Home visiting Home Health Registered Nurse

Hospice Clinical Team Manager (RN Required)

MDS Coordinator

Patient Care Manager - Floater (RN)

Behavioral Health Care Coordinator

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