Medix
Utilization Review RN
Medix, Lake Forest, Illinois, United States, 60045
**THIS ROLE IS FULLY ON SITE 5 DAYS A WEEK**
Responsibilities/ Job Duties:
Determines the most appropriate level of care and admission status and applies approved criteria and guidelines in decision making, as well as managed care rules and practices in order to ensure a smooth admission experience for patients by coordinating clinical needs with operational processes and insurance benefitsCollaborates with the attending physician on appropriate hospital status ordersThe clinical admission nurse does not provide direct patient careChart review is used to assess for appropriate level of care and admission statusAssigns patients to the appropriate units based on clinical assessment while balancing the resources of the organizationCoordinates with unit charge nurse for bed placementCollaborates with nursing operations leader for throughput issuesServes as an access point resource for physicians, staff, and patientsResponds to and assigns all bed request and transfer orders in the electronic medical recordDocuments unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departmentsEvaluates and analyzes quality/utilization cases, admission/discharge criteria, observation/1-day stays, readmits in 30 days, Medicare and diagnosis related criteriaConsults with physicians in assigning admission level of care statusStays up-to-date on Medicare rules and regulations for hospital admission statusPerforms medical record review to assess for appropriateness of admissions and works with the Emergency Room and attending physicians to divert unnecessary admissionsMonitors and documents avoidable days and recommends change in services or processesResponds to requests by the denials management RN for appeal assistanceUtilizes appropriate downtown procedures for bed placement when applicableAssists with data collection and reporting for throughput and bed placementPerforms chart audits as requested by manager/director3-5 Must Have Skills/Qualifications
BSN, RNUtilization Review experienceMCG OR Interqual experienceSchedule/ Shift:
M-F 10am -6pm or 11am-7pm, no weekendsSalary
$100,000-115,000
Medix is acting as an Employment Agency in relation to this vacancy.
Responsibilities/ Job Duties:
Determines the most appropriate level of care and admission status and applies approved criteria and guidelines in decision making, as well as managed care rules and practices in order to ensure a smooth admission experience for patients by coordinating clinical needs with operational processes and insurance benefitsCollaborates with the attending physician on appropriate hospital status ordersThe clinical admission nurse does not provide direct patient careChart review is used to assess for appropriate level of care and admission statusAssigns patients to the appropriate units based on clinical assessment while balancing the resources of the organizationCoordinates with unit charge nurse for bed placementCollaborates with nursing operations leader for throughput issuesServes as an access point resource for physicians, staff, and patientsResponds to and assigns all bed request and transfer orders in the electronic medical recordDocuments unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departmentsEvaluates and analyzes quality/utilization cases, admission/discharge criteria, observation/1-day stays, readmits in 30 days, Medicare and diagnosis related criteriaConsults with physicians in assigning admission level of care statusStays up-to-date on Medicare rules and regulations for hospital admission statusPerforms medical record review to assess for appropriateness of admissions and works with the Emergency Room and attending physicians to divert unnecessary admissionsMonitors and documents avoidable days and recommends change in services or processesResponds to requests by the denials management RN for appeal assistanceUtilizes appropriate downtown procedures for bed placement when applicableAssists with data collection and reporting for throughput and bed placementPerforms chart audits as requested by manager/director3-5 Must Have Skills/Qualifications
BSN, RNUtilization Review experienceMCG OR Interqual experienceSchedule/ Shift:
M-F 10am -6pm or 11am-7pm, no weekendsSalary
$100,000-115,000
Medix is acting as an Employment Agency in relation to this vacancy.