Ingalls Health System Job - 34530528 | CareerArc
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Company: Ingalls Health System
Location: Harvey, IL
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

Join the hospital trusted by Chicago's Southland, Ingalls Memorial Hospital, in this role as a Utilization Review Nurse with the Case Management department.

 

The Utilization Review Registered Nurse, who performs an integrated role incorporating clinical care facilitation, utilization management and discharge planning, in order to facilitate achievement of quality and cost outcomes. The role of the Case Manager also includes working collaboratively with interdisciplinary staff internal and external to the organization and participating in quality improvement and evaluation processes related to the management of care.

 

Essential Job Functions

  • Conducts an initial patient/family assessment on every inpatient to determine psycho-social needs and discharge plans and completes Care Coordination Assessment within the first 48 hours of admission to determine need for Care Coordination intervention. 

  • Performs documentation on a weekly basis in patients' medical charts. Documentation shall include significant patient data, problems defined, assessment goals, treatment plans, date and action taken, summary of same and follow-up activities when indicated. Documentation shall occur more frequently if the situation changes.

  • Participates as a member of the Interdisciplinary Team Conference.

  • Performs a consultative role with staff regarding patients/families.

  • Communicates clinical status updates to patients/families and other involved individuals.

  • Evaluates regularly the appropriateness of the treatment plan in relation to the progress of the patient toward the attainment of stated goals and communicates such with patient and/or family.

  • Reviews final discharge plans and instructions with patient, family, or responsible party, evidenced by documentation in the patient's medical chart.

  • Keeps record on each patient with discharge date and any service patient was referred. This information will be documented in medical record.

  • Performs responsibility of discharge planning for the patient/family and coordinates the discharge plan with the entire rehabilitation team.

 

Required Qualifications

  • Graduation from an accredited school of nursing with a Bachelor's of Science in Nursing (BSN) is required
  • Must hold a current RN Licensure State of Illinois Department of Professional Regulation or valid temporary permit to practice nursing in the State of Illinois
  • Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care.
  • At least 1-2 years of Utilization Review experience in an inpatient setting

Preferred Qualifications

  • 1-2 years of experience in clinical case management or payer experience
  • Prefer ACM or CCM certification or attainment within 2 years of hire
  • Milliman Care Guideline experience

 

Position Details

  • Job Type/FTE: Full-time (0.6) ; 8-hour shifts
  • Shift: Days
  • Unit/Department: Care Management
  • CBA Code: Non-Union


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