Current jobs related to RN Utilization Specialist-Utilization Review Casual Rotating - Palos Heights - Northwestern Memorial Healthcare
-
MRI Technologist
2 weeks ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryThe MRI Technologist - Imaging Casual Rotating position reflects the mission, vision, and values of Northwestern Medicine, adhering to the organization's Code of Ethics and Corporate Compliance Program, and complying with all relevant policies, procedures, guidelines, and regulatory and accreditation standards.Under the general supervision of the...
-
MRI Imaging Specialist
1 week ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob OverviewAt Northwestern Medicine, we're committed to delivering exceptional patient care and fostering a positive work environment. As an MRI Technologist - Imaging Casual Rotating, you'll play a vital role in our mission to provide outstanding healthcare services.Key ResponsibilitiesOperate MRI equipment to obtain high-quality images for MRI procedures...
-
MRI Technologist
1 week ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeAt Northwestern Medicine, we're committed to delivering exceptional patient care and fostering a positive work environment. As an MRI Technologist, you'll play a vital role in our team, operating MRI equipment to obtain high-quality images for MRI procedures.Under the general supervision of the Manager, you'll perform all duties and responsibilities in a...
-
MRI Technologist
1 month ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryWe are seeking a skilled MRI Technologist to join our team at Northwestern Medicine. As an MRI Technologist, you will be responsible for operating MRI equipment to obtain high-quality images for MRI procedures. This is a casual, non-benefited, rotating shift position, working weekends only.Key ResponsibilitiesOperate MRI equipment to obtain...
-
MRI Technologist
2 weeks ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryNorthwestern Medicine is seeking a skilled MRI Technologist to join our team. As a casual rotating shift employee, you will be responsible for operating MRI equipment to obtain high-quality images for MRI procedures.This role is ideal for individuals who are detail-oriented, have excellent communication skills, and are able to work independently...
-
MRI Technologist-Imaging Casual Rotating
2 weeks ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryNorthwestern Medicine is seeking a skilled MRI Technologist to join our team. As an MRI Technologist, you will be responsible for operating MRI equipment to obtain high-quality images for diagnostic purposes. This is a casual, non-benefited, rotating shift position, working weekends only.ResponsibilitiesOperate MRI equipment to obtain high-quality...
-
Imaging Staff Nurse
2 weeks ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryWe are seeking a skilled and compassionate Registered Nurse to join our Imaging Department on a casual rotating shift basis. As a key member of our team, you will provide high-quality patient care and contribute to a positive and supportive work environment.ResponsibilitiesProvide direct patient care and coordinate with support personnel to ensure...
-
Staff Nurse
1 month ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryWe are seeking a skilled and compassionate Registered Nurse to join our Imaging Department on a casual rotating shifts basis. As a key member of our team, you will provide high-quality patient care and contribute to a positive and supportive work environment.ResponsibilitiesProvide direct patient care and coordinate with multidisciplinary team...
-
Registered Nurse RN
2 weeks ago
East Pensacola Heights, United States Ascension Full timeDetails Department: Utilization ReviewSchedule: Full time days; 8:00AM-4:30PM Monday-FridayHospital: Ascension Sacred Heart PensacolaLocation: Pensacola, FloridaBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP)...
-
Utility
2 weeks ago
Airway Heights, United States SSP Full timeJob Description$18.00 / hour Our Utility positions at SSP have the very important role of keeping our restaurants and units clean and sanitized for both our guests and our team. Utility employees are experts in:Having warm, friendly smilesExecuting difficult, essential workHaving high standards If you enjoy creating a clean and safe environment for...
-
Utility
3 weeks ago
Airway Heights, United States SSP Full timeJob Description$18.00 / hourOur Utility positions at SSP have the very important role of keeping our restaurants and units clean and sanitized for both our guests and our team. Utility employees are experts in:Having warm, friendly smilesExecuting difficult, essential workHaving high standardsIf you enjoy creating a clean and safe environment for guests...
-
Utility
2 weeks ago
Airway Heights, United States SSP Full timeJob Description$18.00 / hourOur Utility positions at SSP have the very important role of keeping our restaurants and units clean and sanitized for both our guests and our team. Utility employees are experts in:Having warm, friendly smilesExecuting difficult, essential workHaving high standardsIf you enjoy creating a clean and safe environment for guests...
-
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeAt Northwestern Medicine, we are committed to providing exceptional care to our patients. As a Physical Therapist IHR, you will play a vital role in our team's mission to deliver high-quality healthcare services.The Physical Therapist IHR reflects the mission, vision, and values of Northwestern Medicine, adheres to the organization's Code of Ethics and...
-
Clinical Utilization Management Specialist
3 weeks ago
Shaker Heights, Ohio, United States University Hospitals Full timeAbout the RoleWe are seeking a skilled Clinical Utilization Management Specialist to join our team at University Hospitals. As a key member of our healthcare team, you will play a critical role in ensuring timely and efficient delivery of required workflow, services, and tasks to result in positive patient healthcare outcomes.Key ResponsibilitiesPerform...
-
Utilities Manager
2 weeks ago
Arlington Heights, Illinois, United States PharmEng Technology Americas Full timeJob OverviewPharmEng Technology Americas is seeking an experienced Utilities Manager to provide strategic leadership and guidance in compliance and operational improvement of equipment systems. The ideal candidate will have a strong background in reliability engineering, process improvement, and leadership.The Utilities Manager will be responsible for the...
-
Physical Therapist IHR Outpatient Casual Days
2 weeks ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryNorthwestern Medicine is seeking a Physical Therapist IHR Outpatient Casual to join our team. As a Physical Therapist, you will be responsible for developing and implementing physical therapy programs aimed at maximizing function while educating patients regarding their limitations.Key ResponsibilitiesEvaluate patients and gather appropriate...
-
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryWe are seeking a skilled Social Worker LSW or LCSW to join our team in a casual, non-benefited day shift role. As a Social Worker, you will provide discharge planning and psychosocial interventions to patients and their families, utilizing your knowledge of community resources and social work theories to support patient choice and well-being.Key...
-
Utilities Manager
4 weeks ago
Arlington Heights, Illinois, United States PharmEng Technology Americas Full timeJob Title: Utilities ManagerPharmEng Technology Americas is seeking an experienced Utilities Manager to join our team. As a key member of our operations team, you will be responsible for the development and maintenance of utility systems, ensuring compliance with site and global indicators.Key Responsibilities:Develop and maintain utility master plans,...
-
Project Manager Electric Utilities Specialist
4 weeks ago
Fairview Heights, Illinois, United States Leidos Full timeJob Title: Project Manager Electric UtilitiesLeidos Engineering is seeking a highly skilled Project Manager to join our team in the Electric Utilities sector. As a Project Manager, you will be responsible for managing various sized distribution electric utility projects for public-owned and investor-owned electric utilities located throughout the...
-
Physical Therapist IHR Outpatient Casual Days
2 weeks ago
Palos Heights, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryNorthwestern Medicine is seeking a Physical Therapist IHR Outpatient Casual to join our team. As a Physical Therapist IHR Outpatient Casual, you will be responsible for providing physical therapy services to patients in an outpatient setting. This is a casual (non-benefited) position.Key ResponsibilitiesDevelop and implement physical therapy...
RN Utilization Specialist-Utilization Review Casual Rotating
5 months ago
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 healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?
Job DescriptionThe RN Utilization Specialist 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.
The RN Utilization Specialist (RNUS) is an experienced registered professional nurse with extensive knowledge of patient care, medical treatments, hospital procedures and has expertise in hospital utilization. The RNUS through regular reviews and audits and collaboration with the clinical team, facilitates responsible decisions that promote cost effective health care services as evidenced by appropriate level of care assignment and medical necessity documentation consistent with the patient’s clinical state and intervention plan. The RNUS is a key member of the health care team and as such collaborates with clinicians, responsible for patient care plans, to provide hospital health care benefit coverage information and assist the patients in decisions based on benefits and limitations of coverage plans. The RNUS acts as a change agent to systematically drive change in utilization practices as prioritized by departmental and clinical leadership. As such, the RNUS participates in performance improvement initiatives, implements work process changes, monitors performance, and facilitates necessary changes, under the purview of the Department leadership and in collaboration with practicing clinicians, based on data trends.
Responsibilities:
- Applies medical necessity screening criteria, level of care guidelines, and professional nursing knowledge to ensure that admissions & length of stay are appropriate.
- Completes initial admission and thereafter continuing stay reviews for all hospitalized patients.
- Facilitates utilization review concurrent with decisions on hospitalization and may perform duties in the Emergency Department, pre- and post-operative, labor and delivery, external transfer, bed assignment, and / or other access points for hospitalization.
- Collaborates with the Payor Specialists and third-party payors to effectively communicate all relevant clinical information based on clinical indicators and the plan of care.
- Acts as a liaison with the clinical care team assuring compliance with managed care contracts and payor guidelines while maintaining quality of care.
- Partners with operational and medical leadership to identify, develop and implement utilization processes that foster the right care at the right time in the right setting.
- Monitors data elements inherently related to Utilization through data reporting tools.
- Effectively resolves utilization dilemmas and as needed uses available escalation pathways (Utilization Medical Director (s) or the Lead Utilization Specialists) to secure further information or expertise to resolve identified issues.
- Makes appropriate referrals to internal physician advisors and contracted third party review company per Department guidelines.
- May participate in interdisciplinary discharge planning rounds to facilitate communication with the care team on documentation and orders necessary to assign accurate medical necessity, level of care, and communication with the payor.
- Interfaces with patients as appropriate to provide education on level of care
- Increases stakeholder understanding of best practices in utilization and internal performance against benchmarks, through a variety of educational forums.
- Develops, coordinates, presents, and participates in service-line and clinician education programs.
- Utilizes standardized reports (metrics/dashboard) and provides updates for physicians and the interdisciplinary team members on a regular basis.
- Collaborates with the interdisciplinary team to promote the resolution of barriers related to utilization of services and institute changes that improve systems and promote optimal utilization practices.
- May assist in the reporting of financial indicators including length of stay, resource utilization, denials and appeals.
- Participates in the development, implementation, evaluation and revision of quality utilization tools in collaboration with the healthcare team.
- Assists in Recovery Audit Contractor (RAC) and other audit follow up and contributes to appeals on insurance denials as requested.
Additional Functions:
- Maintains current knowledge of federal and state laws and regulations related to utilization
- Actively participates on departmental and hospital committees and taskforces as assigned
- Complies with Northwestern Medicine policies on patient confidentiality including HIPPA requirements and Personal Rules of Conduct
- Facilitates review of high risk cases by the Office of General Counsel, Corporate Compliance and Integrity, Risk Management and informs appropriate members of the healthcare team as to interventions. Coordinates interventions in collaboration with the healthcare team
- Participates in hospital and department quality improvement initiatives.
Required:
- Licensed Registered Nurse in the state of Illinois (IDFPR)
- Three years of experience in acute inpatient hospital care
- Organizational, team building, coaching, and conflict management to maximize the achievement of utilization outcomes.
- Analytical skills necessary to independently collect, analyze, and interpret data, resolve problems requiring innovative solutions.
- Computer skills including word processing and spreadsheets.
Preferred:
- Bachelor’s Degree in Nursing
Additional Information
Northwestern Medicine is an affirmative action/equal opportunity employer 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.
