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Utilization Review Nurse

Medix Downers Grove Full-Time
$78,000.00 - $85,000.00 / year
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Medix is hiring for an Utilization Review Nurse with an elite Healthcare System. This is an exciting opportunity for you to focus on member needs by assessing, monitoring and optimizing patient health across the continuum of care. This position has the opportunity to go REMOTE after 90 days!

Job Description:

* Effectively communicates in a timely manner to management and internal departments.

* Conducts Pre-certification of all elective admissions with the Health Plan or other certifying entity.

* Receives notification of admissions and maintains admission logs.

* Maintains compliance with all Health Plan guidelines on the reporting of cases/surgeries

* Understands Health Plan policies and procedures regarding pre-certification, benefits by health plan and preferred facilities within each plan.

* Determines appropriate level of care and place of service based on medical information available and criteria application.

* Facilitates discharge planning of members. Performs inpatient utilization review and applies client guidelines as detailed in the client UM Planfor length of stay/admission criteria to approve initial and continued inpatient services.

* Arranges needed post-acute discharge services such as; DME, Home Health, Skilled Nursing

* Coordinates complicated medical cases and retrospective requests with Medical Directors. Requests relevant clinical information and documents in operating system.

BACKGROUND/EXPERIENCE

- An active unrestricted RN License is required
- 1-3 years of utilization review experience required
- Managed Care experience preferred
- 3-5 years of clinical experience required
- Strong computer skills are required (Interqual)




RN Registered Nurse - Nursing - Healthcare - Medical


Benefits

Once you have been a contract employee of Medix for 30 days, you become eligible for our Benefits Program. Should you elect to enroll, there are three levels of medical coverage to choose from, supplemental dental plans and term plans as well as the option to enroll your spouse and/or children. You can select the best combination that best suits your needs.

As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy:

  • 401(k) Retirement Plan
  • A limited benefit medical plan with Starbridge Choices™, a CIGNA plan
  • Doctor visits with inexpensive co-pay
  • Limited Outpatient Care
  • Limited Accident Coverage
  • Prescription Programs
  • Dental Plan
  • Vision Discount Program
  • Term Life Insurance Plans


RN Registered Nurse - Nursing - Healthcare - Medical


Medix - Positively impacting lives every day!

This year's recipient of the Business Ledger's "Entrepreneurial Excellence Growth Award"

"I like the personal relationships that the recruiters set up." - Medix Contractor, RaShawna

Join our network of talented professionals!
Apply today!



 

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Utilization Management
Managed Care
Nursing Homes
Health Policies

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About the company

Salary Details

Based on Job Title, Location and Skills
$82K
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Job ID: 71254

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Launched in 2001, Medix was built on the principle of becoming a leading provider of workforce solutions for clients and candidates across the Healthcare, Scientific and Information Technology industries. As we grow and evolve, we recognize our differentiation lies not just in traditional staffing, but in true partnerships and collaboration on hiring solutions.

We bring value to our talent by helping them identify their individual skills and aptitudes, matching them with opportunities to excel and creating communities where they can foster their skills and always have a trusted partner in their career.

In supporting our clients, we understand that each organization and culture is unique, and we thrive in collaborating with our clients to provide innovative solutions to suit their specific needs.

The root of our growth and continued success stems from not only our loyal clients and talent, but the dedication of our people. Medix takes great pride in our teammates and the culture we built together as an organization. We promote an environment that rewards the hard work and perseverance necessary to solve the unique needs of our clients and talent. The Medix family might span across the country, but our team is tightly united around our core purpose, core values and our mission to provide superior service to our customers.

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