Job Details | RN-Utilization Review Specialist | Full-Time | Lisle, IL (North Region)

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AMITA Health

Location: LisleIL 60532 Document ID: AD204-1IQ4 Posted on: 2019-08-0108/01/2019 Job Type: Regular

Job Schedule:Full-time
2019-08-31
 

RN-Utilization Review Specialist | Full-Time | Lisle, IL (North Region)

We Are Hiring

RN-Utilization Review Specialist

Full-Time (Exempt)

Location: Amita Health Corporate Offices: 2601 Navistar Drive, Lisle, IL 60532

Why Join AMITA?

AMITA Health (www.AMITAhealth.org) is a joint operating company formed by the Adventist Health System in Altamonte Springs, FL and St. Louis, MO based Ascension.

AMITA Health is the largest health system in Illinois, comprising 19 hospitals and more than 230 sites of care. The health system has 900 providers in its medical groups, more than 26,000 associates and 7,000 physician partners and serves over 4.3 million residents in the greater Chicagoland area.

What You Will Do

As an Associate with AMITA Health, you will have the opportunity to
Provides health care services regarding admissions, case management, discharge planning and utilization review.
Responsibilities:
  • Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.
  • Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assesses and coordinates discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.

What You Will Need

Licenses/Certifications/Registration:
  • Required Credential(s):
    • Registered Nurse obtained prior to hire date or job transfer date.

Education:
  • Diploma
    • Diploma from an accredited school/college of nursing required.
    • BSN preferred.

Work Experience:
  • At least two years of UR experience preferred.
  • BSN preferred.

Equal Employment Opportunity

AMITA Health will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.
     
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