Utilization Review Registered Nurse, Registry, Days

2 weeks ago

Crown Point, United States The University of Chicago Medicine Full time
Job Description

Join a world-class academic healthcare system, UChicago Medicine Crown Point, located in Crown Point, Indiana as a Registry Utilization Review Registered Nurse. UChicago Medicine is an integrated academic and community health system with multiple primary medical facilities within the surrounding suburbs of Chicago.  UChicago Medicine, Crown Point is a new two-story, 130,000-square-foot multispecialty care center and micro-hospital in Northwest Indiana for what will be the academic health system's largest off-site facility and its first freestanding building in Indiana.

The Registry Utilization Review RN evaluates and monitors pre-admission review and the admission process by using established criteria as mandated by the hospital, departmental, Joint Commission, government, and third-party payor policies/procedures. Reviews Requests for Admission for diagnosis and procedure(s) for inpatient type. Facilitates the communications between insurance companies, review agencies and physicians regarding inpatient pre-authorizations and admissions. 

Essential Job Functions:

  • Remains current on all UCM NWI managed care contracts and shares requirements and changes in requirements, with staff to ensure payment to the Hospital is not jeopardized. 
  • Remains current on city, state, federal, and third-party payor regulations affecting the inpatient preadmission/admission process as it relates to the medical criteria and ongoing utilization standards, including but not limited to Joint Commission and the Health Care financing Administration (HCFA). 
  • Provides staff with updates in requirements to ensure admission to the acute care setting is necessary and the Hospitals are in compliance with Joint Commission standards and HCFA regulations. 
  • Interacts with health care providers to identify medical necessity and appropriateness of admission to the inpatient setting and provides feedback to staff on appropriate documentation to support the need for admission. 
  • Works with staff to assure that patients with complex diagnoses or care setting requirements are pre-certified in accordance with any payor requirements. 
  • Facilitates the communication between external and internal disciplines regarding pre-authorization. 
  • Takes an active role in resolving pre-certification and insurance issues identified. 
  • Reviews pre-admissions of patients undergoing procedures to determine appropriateness of inpatient type. 
  • Follows up with admitting service to insure additional clinical information has been provided to the review organization as requested.
  • Participates in all Admission Services activities including pre-admission, admission, and follow-up work. 
  • Reviews, develops, recommends, and implements goals and objectives for the preadmission process. 
  • Reports on issues/problems identified in current processes and outcomes. 
  • Performs other duties as requested by senior management. 

Required Qualifications:

  • RN with current license in the State of Indiana required
  • A Bachelor's degree in nursing, health field or business required. 
  • Three years prior nursing experience in a hospital required with previous utilization review experience required.
  • Must have knowledge of governmental and accrediting agency requirements and knowledgeable of managed care, HMO's and PPO's.
  • Solid understanding of Peer Review Organization criteria and standards, purpose and requirements needed.
  • Working knowledge of DRG payment system is helpful
  • Active BLS certification from the American Heart Association (AHA)

Position Details:

  • Job Type/FTE: Registry (.10FTE)
  • Shift: Days
  • Work Location: Crown Point 
  • Unit/Department: Inpatient Union
  • CBA Code: Non-Union
Why Join Us

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: UChicago Medicine Career Opportunities.

UChicago Medicine is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Must comply with UChicago Medicine’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.

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