Utilization Review Nurse - 20026

This position reviews services to patients of all ages to ensure appropriate status of admission, length of stay and utilization of criteria based Severity of Illness/Intensity of Service. Utilizes clinical and nursing knowledge of documentation requirements to improve overall quality and completeness of clinical documentation of patient records.

Nurse with current Illinois RN or LPN license.  Five years experience in clinical nursing or discharge planning is required.

• Performs admission, concurrent, and focused reviews using InterQual criteria and CMS regulations.
• Maintains appropriate documentation of reviews.
• Refers medical records to physician advisors for secondary reviews.
• Follows up with admitting providers to discuss status orders as necessary.
• Performs telephone reviews as requested to obtain pre-certification and continued stay certification with private carriers and/or review firms.
• Participates in unit patient care rounds when possible.
• Serves as a resource person to physicians and hospital staff in the appropriate use of health care resources.
• Accepts on-call as scheduled and responds as needed.
• Takes responsibility for upgrading professional skills and knowledge.
• Prepares and completes reports; participates in special projects.
• Performs other duties as assigned.