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We Are Hiring! At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!
FTE: 0.300000
Shift: Nights
Location: RIVERSIDE MEDICAL CENTER
SummaryThe Utilization Review Nurse in the Emergency Department is responsible for assuring the most appropriate level of care and status of the patients thru collaboration with the ED providers, residents, admitting physician, social worker, case manager, and nursing staff. This position also collaborates nursing leadership and other support departments to manage patient placement, throughput, and capacity.
Experience/Education Requirements
Clinical preparation as a Registered Nurse
Graduate of an approved school of nursing, BSN preferred.
Minimum of 3-5 years of acute care experience
Bi-lingual is an asset
Excellent interpersonal communication and negotiation skills
Able to easily adjust to the rigorous demands of the Emergency Department
License Or Certification Requirements
Current Illinois RN license.
Responsibilities
Alert the inpatient case managers to high risk/challenging patients being admitted through the ED.
Assess/screen all potential admissions for medical necessity and level of care needs and makes recommendation to assign accurate status of inpatient or observation status.
Screens patients for social work, home care and continuing needs.
Maintains records documenting productivity and outcomes of interventions.
May provide pre-admission/initial/concurrent review to regulatory agencies and contracted insurers.
Provide information on a consistent basis to the Emergency Department staff/physicians and hospitalist admitting physicians on InterQual and/or Milliman criteria for admission, Medicare and Medicaid rules and regulations, severity of illness and intensity of service indicators, and federal, state or accrediting agency initiatives regarding safety and quality measures.
Refers patients to the ED social worker when patient does not qualify for acute level of care but needs a safe discharge from the ED.
Using preliminary diagnosis, makes recommendations for documentation to support physicians determination of Severity of illness and treatment plan.
Actively participates in organizational improvement processes including committees impacting patient placement and throughput.
Performs miscellaneous job related duties as requested.
Proactively facilitates throughput of all patients by monitoring for census peaks including surgical and procedural patient placement.
Proactively facilitates throughput of all patients in observation status by collaborating with nursing and physicians assigned to the patient care team.
Proactively facilitates throughput of all patients by working with nursing units and leaders to identify best available bed placement at the time of request, given patient needs, staffing resources, level of care requirements, infection control and throughput goals.
Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.
Other InformationExposure/Sensory Requirements
Exposure ToChemicals: White out for correction of typing/writing corrections.
Video Display Terminals: Average
Blood and Body Fluids: Low risk
TB or Airborne Pathogens: Low risk.
Sensory Requirements (speech, Vision, Smell, Hearing, Touch)Speech: Required to communicate with physicians, hospital staff, and outside agencies.
Vision: Needed to perform chart review data, computer screen work, reading data and information.
Smell: NA
Hearing: Needed for telephone communication.
Touch: Needed to write, computer entry, individual pages of chart for review.
Activity/Lifting Requirements
Average Hours per Week: 40
Shift: Days
Percentage of time during the normal workday the employee is required to: Sit: 70%
Twist: 2%
Stand: 10%
Crawl: 0%
Walk: 9%
Kneel: 1%
Lift: 4%
Drive: 0%
Squat: 1%
Climb: 0%
Bend: 2%
Reach above shoulders: 1%
The weight required to be lifted each normal workday according to the continuum described below: Up to 10 lbs: Continuously
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting charts, notebook, notebook computers, office supplies. Carrying review books and notebook computers from department to nursing units. Charts carried from Medical Records to department. Handling files in file cabinet. Lifting manuals and reference information.
Maximum consecutive time (minutes) during the normal workday for each activity: Sit: 120
Twist: 1
Stand: 30
Crawl: 0
Walk: 10
Kneel: 1
Lift: 5
Drive: 0
Squat: 1
Climb: 0
Bend: 2
Reach above shoulders: 1
Repetitive Use Of Hands (Frequency Indicated)Simple grasp up to 10 lbs. Normal weight: 80%
Pushing & pulling Normal weight: 4x/wk
Fine Manipulation: Computer entry, writing.
Repetitive use of foot or feet in operating machine control: None
A utilization management nurse's job description includes examining medical treatments and interventions to avoid payment denial and optimizing reimbursem*nts by assessing the treatment's appropriateness, effectiveness, timing, and setting.
A Concurrent Review Nurse is responsible for managing inpatient and observation services in order to determine if a patient will remain at a healthcare facility or be discharged.
UM work is not direct patient care – it is primarily conducted using a computer and a telephone. While UM nurses do manipulate a lot of data, the work is highly clinical.
There are three types of utilization reviews: Prospective review: determines whether services or scheduled procedures are medically necessary before admission. Concurrent review: evaluates medical necessity decisions during hospitalization. Retrospective review: examines coverage after treatment.
Like most nursing roles, working as a utilization review nurse comes with a high stress level. Working as a utilization review nurse can be stressful, as it may involve situations and settings in which nurses must make difficult decisions that they may not personally agree with.
Utilization management nurses are responsible for coordinating care and ensuring that patients receive the most appropriate level of care for their needs. This can be a very demanding job, and if you do not have good time management skills, it can be challenging to keep up with everything that needs to be done.
Under general supervision, review medical records of patients who are under treatment for emotional or mental illness to ensure proper utilization of treatment resources; review patient records for proper case documentation, and medical necessity of treatment in relation to federal, state and county regulations; assess ...
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