EPH Registered Nurse

7 days ago

Rolling Meadows, United States Advocate Health Full time

Performs telephonic utilization management and associated discharge planning/authorization for AAH delegated risk and ACO members, to ensure appropriate level of care, excellent clinical outcomes, and to optimize the appropriate use of resources in the most cost-effective setting.

Major Responsibilities:

  • Responsible for performing telephonic utilization management for network and non-network hospital admissions. Ensures appropriate admissions are to network facilities; works with PCP to redirect admission as indicated by the patient's condition.
  • Facilitates AAH APP and Medical Group members transfer from out of network hospitals to Advocate Hospitals. Utilizes nationally recognized criteria to provide continuous assessment of medical necessity, level of care and medical needs, including identification of AHD (avoidable hospital days). Provides updates to HMOs regarding admission and concurrent medical status of patients when required.
  • Works closely with Primary Care Physicians, Hospitalists, Specialists and Medical Directors when necessary to clarify treatment plans and goals. Reviews questionable stays with Medical Director. Coordinates and issues necessary letters, notifications, and documents to comply with AAH and MCO's utilization and/or denial policy.
  • Facilitates safe and timely discharges from the hospital to alternative levels of care (i.e., SNF, home care). Screens all cases for designated quality indicators and reports questionable situations to the manager. Cognizant of all other department duties and functions, such as quality, case management, referrals and provider relations and understands how and when to interface with them.
  • Complies with all necessary documentation requirements to meet AAH, MCO, and regulatory agency requirements. Reviews and resolves pended claims issues as needed. Achieves and maintains score >90% on the inter-rater reliability audit. Cognizant of/participates in site specific focus reviews, goals and action plans. Responsible for the coordination, monitoring and authorization of discharge planning from non-network and network hospitalizations to foster efficient cost-effective care and quality outcomes to members in accordance within benefit coverage guidelines.
  • Evaluates members' social, functional status, and health care needs to develop a timely and appropriate discharge plan. Provides member/ family education and emotional support as indicated. Communicates discharge plans to patient, family and/or hospital staff as appropriate. Authorizes contracted vendors for home health, DME and skilled nursing facilities. Assures vendors receive clinical information to provide services efficiently and safely.
  • Refers appropriate questions to UM Medical Director regarding cases with unclear medical necessity. Updates and maintains all HMO contract/benefit policies/procedures, preferred provider listing and other pertinent procedures related to UM and referral management. Updates all patient complaint and grievance inquiries with regard to inpatient facility or ancillary providers.
  • Coordinates an HMO-contracted provider/vendor for discharge planning referral needs when indicated. Refers complex cases to appropriate case manager for ongoing case management. Communicates and interacts with internal and external providers and administrators in a positive, professional fashion in order to promote the delivery of quality care and effective multi-department/system function.
  • Serves as a resource person for contracted physician groups. Provides timely and necessary information to the Inpatient UM analysts to ensure accurate statistics. Participates in hospital meetings necessary to maintain optimal work functions and environment. Updates necessary hospital personnel of approvals, denials, discharge plans. Completes necessary chart documentation.
  • Initiates effective and efficient communication with the Attending Physician/PCP/Hospitalist/Specialist to ensure timely and appropriate discharges. Attends necessary meetings with department. Completes necessary paperwork for efficient department operations. Participates in ongoing physician education as appropriate. Interacts with physicians and staff as necessary. Educates hospital personnel, vendors regarding managed care.


Licensure, Registration, and/or Certification Required:

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


Education Required:

  • Bachelor's Degree in Nursing.


Experience Required:

  • Typically requires 3 years of experience in a clinical role with at least one year of previous utilization review, discharge planning or case management experience.


Knowledge, Skills & Abilities Required:

  • Ability to handle multiple tasks.
  • Ability to intervene and handle difficult situations.
  • Good verbal and written communication skills. Excellent interpersonal communication and problem-solving skills.
  • Ability to work independently and prioritize assignments, using independent judgement and discretion.
  • Good computer and keyboard proficiency.
  • Demonstrated initiative in process improvement recommendations.
  • Ability to anticipate potential problems and intervene appropriately.


Physical Requirements and Working Conditions:

  • This position requires travel, therefore, will be exposed to weather and road conditions.
  • Operates all equipment necessary to perform the job.
  • Exposed to a normal office environment.
  • Able to handle stress and high workload volumes.
  • Flexible with work assignments.
  • Ability to be cross trained as necessary.
  • Ability to effectively communicate denial of services to members and / or providers.


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.

  • Registered Nurse

    50 minutes ago

    Rolling Meadows, Illinois, United States Fresenius Medical Care North America Full time

    About This RoleFresenius Medical Care North America is seeking a highly skilled Registered Nurse to join our team as a Home Therapies Registered Nurse. As a key member of our nephrology healthcare team, you will play a vital role in providing exceptional patient care and education to patients with kidney disease.Key ResponsibilitiesParticipate in...

  • Registered Nurse

    2 days ago

    Rolling Meadows, United States Fresenius Medical Care Holdings, Inc. Full time

    Paid one on one training and education provided Empower, engage and train dialysis patients on peritoneal and home hemodialysis using state of the art training programs and equipment​ Primarily works in the clinic setting and conducts initial home visits with another staff member present​ Position functions as an onsite Patient Educator and Case Manager...

  • Certified Registered Nurse Anesthetist

    6 days ago

    Rolling Meadows, Illinois, United States Endeavor Health Services Full time

    Job SummaryWe are seeking a highly skilled Certified Registered Nurse Anesthetist (CRNA) to join our team at Endeavor Health Services. As a CRNA, you will be part of our Anesthesia Care Team, working collaboratively with physicians and other healthcare professionals to provide high-quality patient care.Key ResponsibilitiesDeliver anesthesia care to patients...

  • Geriatric Nurse

    1 week ago

    Rolling Meadows, Illinois, United States Favorite Healthcare Staffing Full time

    Job OpportunityWe are seeking an experienced Geriatric Registered Nurse to join our team at Favorite Healthcare Staffing. As a Geriatric RN, you will have the opportunity to work with a variety of patients and provide high-quality care in a dynamic and supportive environment.Position Details:• Employment Type: Part-Time to Full-Time Per Diem / PRN•...

  • Travel Nurse RN Position

    4 weeks ago

    Rolling Meadows, United States TotalMed Staffing Full time

    Job Title: ICU Registered Nurse TotalMed Staffing is seeking a skilled ICU Registered Nurse for a travel nursing assignment in Illinois. Job Details: Specialty: ICU - Intensive Care Unit Discipline: RN Duration: 12 weeks Shift: 12 hours, nights Employment Type: Travel We are looking for a dedicated and experienced Registered Nurse to join our team in...

  • Travel Nurse RN Position

    4 weeks ago

    Rolling Meadows, Illinois, United States TotalMed Staffing Full time

    Job Title: ICU Registered NurseTotalMed Staffing is seeking a skilled ICU Registered Nurse for a travel nursing assignment in Illinois.Job Details:Specialty: ICU - Intensive Care UnitDiscipline: RNDuration: 12 weeksShift: 12 hours, nightsEmployment Type: TravelWe are looking for a dedicated and experienced Registered Nurse to join our team in Arlington...

  • Geriatric Nurse

    2 weeks ago

    Rolling Meadows, Illinois, United States Favorite Healthcare Staffing Full time

    Job OpportunityAt Favorite Healthcare Staffing, we connect candidates with jobs that fit their unique needs. We place nursing, advanced practice, and allied healthcare professionals in top-rated facilities across the country. With thousands of per diem opportunities, local and travel contracts, or permanent and temp-to-perm placement jobs to choose from, our...

  • Travel Nurse RN Position

    4 weeks ago

    Rolling Meadows, Illinois, United States Advantis Medical Full time

    Travel Nursing Opportunity in Arlington HeightsAdvantis Medical is seeking an experienced ICU Registered Nurse (RN) for a travel nursing job in Arlington Heights, IL.Job DetailsContract Length: 12 WeeksShift: NightsStart Date: ASAPWe offer a competitive pay package based on 12 hour shifts and 36 hours per week, with a tax-free stipend amount to be...

  • Nurse Career Opportunities

    4 weeks ago

    Rolling Meadows, Illinois, United States Lutheran Life Communities Full time

    Start a New Career as a Registered NurseAt Lutheran Life Communities, you will embark on a fulfilling career in a faith-based, mission-driven organization where our team members are supported and empowered to serve. Our culture promotes growth, recognition, and investment in our team's success.Why Choose Lutheran Life Communities?A mission to connect with...

  • Dermatology Nurse Practitioner

    4 weeks ago

    Rolling Meadows, United States Priority Physicians, Inc. Full time

    DocCafe has an immediate opening for the following position: Dermatology Nurse Practitioner in Rolling Meadows, Illinois. Make $140000/yearly - $250000/yearly.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe...

  • Hospice Nurse Specialist

    3 days ago

    Rolling Meadows, Illinois, United States LHC Group Full time

    Hospice RN Case Manager Job DescriptionWe are seeking a compassionate and skilled RN Case Manager to join our Hospice team at Caretenders Hospice, a part of LHC Group. As a Hospice RN, you will play a vital role in delivering high-quality, patient-centered care to individuals and their families.Responsibilities:Conduct initial nursing evaluations to...

  • Nurse Practitioner

    4 weeks ago

    Rolling Meadows, United States Oak Street Health Full time

    Title: Nurse Practitioner - Advanced Practice ProviderSchedule: Full-Time, Monday through Friday, 8:00 AM - 5:00 PMLocation: Chicagoland Suburbs. For a list of all applicable centers, see locationsRole Description:The purpose of a Nurse Practitioner at Oak Street Health is to provide effective and equitable value-based primary care to adults on medicare to...

  • Hospice Care Specialist

    3 days ago

    Rolling Meadows, Illinois, United States Moments Hospice Full time

    About Moments HospiceMoments Hospice is a leading organization dedicated to providing personalized care and treating patients like family. Our mission is to make our patients' final days, weeks, and months as comfortable as possible.Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Case Manager. As a RN Case Manager, you will be...

  • Hospice Aide/CNA

    1 month ago

    Rolling Meadows, United States LHC Group Full time

    Summary We are hiring for a Hospice Aide / CNA. At Caretenders Hospice, in Rolling Meadows,IL, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve-it truly is all about helping people. You can find a...

  • Healthcare Support Specialist

    4 weeks ago

    Rolling Meadows, Illinois, United States Ascension Full time

    About Our CommunityAlexian Brothers Ambulatory Group Rolling Meadows, part of Ascension Living, offers a unique blend of personalized care, exceptional services, and city comforts in a beautiful community setting.We are committed to providing a supportive environment that enables seniors to thrive at every age and stage of life.As a national nonprofit senior...

  • Medical Assistant

    2 weeks ago

    Rolling Meadows, Illinois, United States Ascension Full time

    About UsAlexian Brothers Ambulatory Group Rolling Meadows, part of Ascension Living, offers a unique blend of personalized care, exceptional services, and city comforts in a beautiful community setting.We are committed to providing services, amenities, opportunities, and support to help seniors live healthier and happier at every age and stage.Our...

  • Healthcare Support Specialist

    3 weeks ago

    Rolling Meadows, Illinois, United States Ascension Full time

    About Our CommunityAlexian Brothers Ambulatory Group Rolling Meadows, part of Ascension Living, offers a unique blend of personalized care, exceptional services, and city comforts in a beautiful community setting.We are committed to providing a supportive environment where seniors can thrive and enjoy living healthier and happier at every age and stage.Our...

  • Patient Care Technician

    1 month ago

    Rolling Meadows, United States Ascension Full time

    Alexian Brothers Ambulatory Group Rolling Meadows, part of Ascension Living brings it all together for you at our beautiful community. You will have access to personalized care, exceptional services with a balance of city comforts, cultural opportunities and more, in our community and close by.We are committed to providing services, amenities, opportunities,...

  • Patient Care Technician

    2 weeks ago

    Rolling Meadows, United States Ascension Full time

    Alexian Brothers Ambulatory Group Rolling Meadows, part of Ascension Living brings it all together for you at our beautiful community. You will have access to personalized care, exceptional services with a balance of city comforts, cultural opportunities and more, in our community and close by.We are committed to providing services, amenities, opportunities,...

  • Clinical Utilization Manager

    7 days ago

    Rolling Meadows, Illinois, United States Advocate Aurora Health Full time

    Job SummaryWe are seeking a highly skilled Clinical Utilization Manager to join our team at Advocate Aurora Health. As a key member of our utilization management team, you will play a critical role in ensuring that our patients receive the most appropriate level of care while minimizing unnecessary costs.Key ResponsibilitiesPerform telephonic utilization...