Job Description
This position is in the ED: 6:00pm -2:00AM. Monday through Friday. No weekends /holidays. This is not a remote position.
The Utilization Management RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Utilization Management nurse role is to ensure that health care services are administered with quality, cost efficiency, and within compliance by continuously reviewing the EMR and collaborating with the health care team.
Responsibilities:
- Concurrent review of patients clinical information for efficiency and correct level of care and admission status
- Interface with payers concurrently and after discharge to obtain authorization
- Concurrent denials management
- Collaborates with the denials management team
- Ongoing review of pre-certification requests for medical necessity
- Monitor the activities of clinical and non-clinical staff
- Collaborates with the health care team and payers to assist with coordinating patients discharge planning needs
- Employ effective use of knowledge, critical thinking and skills
- Work in an intensive, fast-paced environment with minimal supervision
- Ability to stay organized and interact well with others in any situation
- Provide updates to Director of Utilization Management for review
Qualifications
Required:
- Bachelor's degree in Nursing
- State licensure as a Registered Nurse (RN)
Preferred:
- Master's degree
- Minimum 2 years of prior experience in Utilization Management
- Utilization Management or Case Management certification
Additional Information
Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Background Check
Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure
Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
