Top 6 Utilization review nurse Jobs in Waukegan Il

Case Manager RN-Utilization Review Casual Rotating Shift
Northwestern Memorial Healthcare —Lake Forest, IL
- $40.50 - $64.80 an hour
- Part-time
- Background check
- Nursing
- RN License
- Tuition reimbursement
- 401(k) matching
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4d
Case Manager Full Time and PRN
AHS Vista LLC —Waukegan, IL
- $36 - $55 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- Dental insurance
- 401(k)
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Remote Utilization Management Nurse (RN or LVN – CA Lic. Req.) | Preservice/Denials Dept.
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Travel reimbursement
- Health savings account
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3d

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
11d
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
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utilization review nurse jobs near waukegan il

Case Manager RN-Utilization Review Casual Rotating Shift

Northwestern Memorial Healthcare -
Lake Forest, IL

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Job Details

Part-time
$40.50 - $64.80 an hour
4 days ago

Benefits

Tuition reimbursement
401(k) matching
Loan forgiveness

Qualifications

RN License
Bachelor of Science in Nursing
Bachelor's degree in nursing

Full Job Description

Company Description

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better?

Job Description

**This is a remote casual position supporting Utilization Review at Catherine Gratz Griffin Lake Forest Hospital. This position is to provide additional staffing coverage for the department and does not have a set schedule. Looking for someone who is able to work weekdays and weekends. Scheduled for this role is 6a to 6p or 6p to 6a. **

The Case Manager, RN (PT) reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities:

Develops individualized treatment plans for patients, in collaboration with the patient, their family and
Coordinates and leads care conferences on patients with length of stays greater than 7 days.
Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departments.
Assesses patient and family needs for appropriate discharge services.
Coordinates transfer to appropriate level of care such as skilled care, rehabilitation, custodial and home health care.
Documents discharge planning on the interdisciplinary plan of care, in progress notes and education record.
Maintains current knowledge of resources available in the community to support a continuum of effective services for the patient.
Delivers notice of Medicare discharge appeal rights within the appropriate time frame.
Assists physician in assigning admission status.
Performs medical record review to assess for appropriateness of admissions and continued hospital stay.
Monitors avoidable days and recommends change in services or processes.
Educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.
Ensures compliance with managed care contracts and length of stay targets while maintaining quality of care.
Develops and educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.
Distributes hospital issued non coverage notices.
Monitors documentation of an appropriate diagnosis for outpatient/observation testing and queries physicians/APPs as needed following AHIMA guidelines.
Responds to requests by patient financial services for appeal assistance.
Supports Denials Lead RN on Appeals insurance denials for medical necessity for inpatient and outpatient services.
Completes documentation worksheet.
Queries physician for clarification or missing documentation.
Performs chart audits for documentation compliance with CMS standards.
Obtains appropriate documentation to comply with core measure standards.

Qualifications

Required

Registered Nursing license issued by the State of Illinois.
Bachelors of Science Nursing
3 or more years of related clinical experience

Preferred

Masters of Science Nursing
Membership in Professional Nursing Organization
Certification in Case Management (ACM)

Additional Information

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.

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utilization review nurse jobs in waukegan il

Case Manager RN-Utilization Review Casual Rotating Shift

Case Manager Full Time and PRN

Remote Utilization Management Nurse (RN or LVN – CA Lic. Req.) | Preservice/Denials Dept.

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