Utilization Review Nurse
New
R
Rising Medical SolutionsHealthcare
Chicago, Illinois, United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
- Required Skills
- Microsoft Excel
Requirements
- Associate's or Bachelor's degree in Nursing
- Active and unencumbered RN license
- 3 to 5 years of clinical practice experience OR 2 years of case management and/or UR experience
- Experience with Workers' Compensation, short-term or long-term disability, or liability claims
- General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
- Working knowledge of Microsoft Word, Excel, and Outlook
- Excellent analytical skills
- Superb oral and written communication skills
- Strong interpersonal and conflict resolution skills
Responsibilities
- Perform all aspects of the Utilization Review Process
- Review records and requests for UR from various communication channels
- Utilize evidence-based guidelines for authorization determinations
- Write nurse summaries on all UR files
- Document in databases and send determination letters
- Establish collaborative relationships with internal and external stakeholders
- Track status of UR activity to ensure timely turn-around
- Maintain organized clinical documentation files
- Respond to written and telephonic inquiries
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