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Title:  Utilization Management Nurse

Req #:  111216
Facility:  Support Centers
Department:  Nursing
City:  Oak Brook
Posting Budget Status:  Day
Shift Type:  Full Time - Permanent
Posting FTE:  1

Advocate Health Care, the largest health system in Illinois and one of the largest health care providers in the Midwest. Our Corporate Support & Operations Services are equally committed to advancing Advocate's goal of building lifelong relationships with patients by delivering the best health outcomes and highest level of service through an integrated approach to care and wellness.

Position Requirements:
BS or BSN
2yrs of hospital nursing, hospital case management, insurance case management, or utilization management experience preferred Knowledge of clinical practice norms.
Excellent communication skills.

Critical thinking skills
Organization, planning, and time management skills.
Current nursing license in State of Illinois

Ability to be flexible and work in the changing health care/payer environment

Ability to prioritize independently and respond to multiple
simultaneous requests



May require carrying approximately 8 pound laptop to nursing unit(s)


Purpose:
Responsible for determining the correct level of care. Serves as a liaison between the hospital and external payers on issues related to severity of illness and intensity of service for patients to insure reimbursement. Insures appropriate utilization of hospital services.

Accountabilities:
Medical record review for severity of illness and intensity of service.
Liaison function with external review agencies to insure compliance with regulations affecting financial reimbursement to the hospital.
Identifies the variances from established plans of care, pathways, algorithms and guidelines, and facilitates the development of action plans.
Responsible for development and professional practice.

About Advocate Health Care

 

Advocate Health Care, named among the nation’s Top 5 large health systems based on quality by Truven Analytics, is the largest health system in Illinois and one of the largest health care providers in the Midwest. Advocate operates more than 250 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, the state’s largest emergency and Level I trauma network, one of the area’s largest home health care companies, and the region’s largest medical group. Advocate Health Care has 4 teaching hospitals and is a not-for-profit, mission-based health system affiliated with the Evangelical Lutheran Church in America and the United Church of Christ.


Nearest Major Market: Chicago