Are you interested in working with a leading healthcare organization ?
We are seeking an experienced and highly motivated Nurse Certification Coordinator focused on Utilization Review to join our Case Management team at Rush University Medical Center!
The Nurse Certification Coordinator assists in maintaining patient insurance certification, denial avoidance, and/or working post discharge level of care work queues. Utilization review activities.
Principal Duties and Responsibilities:
Reviews cases for commercial and governmental payers, applies criteria and the concurrent/post discharge review process to maintain certification at the appropriate level of care.
Functions as an expert clinical practitioner and resource within the Certification/Level of Care team regarding admission and ongoing stay reviews Manages complex caseload, completes tasks on task list within designated work hours.
If assigned to the ED: Initiates evaluation of anticipated post-acute care needs which focuses on the specific goals, preferences, and needs of the patient.
Supports process improvement and problem resolution.
Utilizes the CM information system and appropriate technologies.
Assist with training, and orientation for staff and new employees as needed.
Provides Team and Department support. Promotes customer satisfaction among patients, families, physicians, external case managers, payers, vendors, Care Managers, Patient Access, and Collections/Billing staff.
Knowledge, Skills and Abilities:
Illinois Registered Nurse (RN) licensure required.
Bachelor's degree from an accredited university required (except current employees working before May, 2016).
Three or more years of experience as a health care provider for the neonate, pediatric, adolescent, adult and/or geriatric patients required. Of the three years' experience, at least one (1) year experience in care management, discharge planning, social service, and criteria application preferred.
Utilization review experience preferred
Certification in criteria application or Care Management is required (or a commitment to obtain with. 2.5 years).
Prior training /experience with nationally accepted clinical criteria, willingness to complete criteria training and meet InterQual Interrater Reliability expectations.
Excellent Customer service skills required.
Ability to perform tasks independently, prioritize workload, and interpret data is required.
Experience or ability to master information systems and windows technology and competency within the CM Information System(s).
Team building skills are required.
Rush's new 14-story hospital is the cornerstone of the Rush Transformation, an ongoing effort to build new facilities, renovate existing buildings and adopt new technology.
As an academic medical center, Rush University Medical Center in Chicago, Illinois, is committed to advancing medical knowledge through research. Investigators at Rush are involved in more than 1,600 projects, including hundreds of clinical studies to test the effectiveness and safety of new therapies and medical devices, as well as to expand scientific and medical knowledge.
Rush University Medical Center is a four time Magnet facility located in Chicago, IL www.rush.edu
Leading academic medical center, acute care hospital with 676 licensed beds. #LI-SK1
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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2019 rush university medical center
Rush University Medical Center