Utilization Review Nurse- Part Time or Full Time
The successful candidate will render accurate first level utilization and quality review determinations based upon application of approved medical necessity criteria and quality screens.
Requirements:
- An active, unrestricted Illinois registered nurse license
- Minimum of three years in a comprehensive acute care setting
- Strong working knowledge in utilization and/or quality assurance review preferred.
- Strong verbal and written communication skills are required.
Preferred:
- B.S. degree in Nursing or other health related field.
- CPUR certification preferred.
- Working knowledge of InterQual® or other UR criteria.
Essential Responsibilities:
- Performs admission/concurrent medical record reviews via telephone or web, to include the application of qualifying criteria and coding and renders accurate review determinations.
- Performs retrospective medical record review, including the application of medical necessity criteria, coding and DRG validation, and identification of potential quality of care concerns, and renders accurate review determinations.
- Accurately enters all review information, clearly documenting the review determination and supporting clinical information into eQSuite™, resulting in either a system generated approval letter or an eQHealth Physician Referral if case cannot be certified by URC.
- Places incomplete cases in pending status for additional clinical information
In exchange for your experience and capability, we offer a Monday-Friday schedule, competitive salary and an outstanding benefits package available to full time employees that includes medical, dental, 403 (b), short and long term disability and more. Qualified applicants should submit their resume and salary requirement to:
eQHealth Solutions (formerly HealthSystems of Illinois)
2050-10 Finley Road
Lombard, Illinois 60148
www.eqhs.org
Fax: 630-317-5202
Email: HR@eqhs.org
EOE