RN-Utilization Review

Profile

Details

Department: Total Quality Management

Schedule: 8:00am-4:30pm, 4 weekend shifts within 6 week period

Hospital: Alexian Brothers Healthcare System

Location: Fully Remote

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Connect with your Talent Advisor today for additional specifics.

Responsibilities

Provide health care services regarding admissions, case management, discharge planning, and utilization review.

Review admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.

Provide case management and/or consultation for complex cases.

Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals.

Assess and coordinate discharge planning needs with healthcare team members.

May prepare statistical analysis and utilization review reports as necessary.

Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

Requirements

Licensure / Certification / Registration:

Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date or jobtransfer date required.

Education:

Diploma from an accredited school/college of nursing OR Required professional licensure at time ofhire.

Additional Preferences

RN must reside in Illinois, and have an active IL RN license in good standing.

Why Join Our Team

Ascension Illinois delivers compassionate, personalized care throughout Chicago and its surrounding suburbs. As one of the largest health systems in Illinois with 15 hospitals and more than 230 sites of care, you will find an environment that allows you to thrive and create a career path you love. Join a diverse team of more than 17,000 associates and more than 600 providers who are dedicated to providing compassionate, personalized care to all.

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, 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.

For further information, view the EEO Know Your Rights (English) (https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRights_10_20.pdf) poster or EEO Know Your Rights (Spanish) (https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRightsSp_10_20.pdf) poster.

Pay Non-Discrimination Notice (https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_ English_formattedESQA508c.pdf)

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

This employer participates in the Electornic Employment Verification Program. Please click the E-Verify link below for more inforamtion.

E-Verify (https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf)

Company info

athenahealth, Inc.
Website : http://www.athenahealth.com