Regional Utilization Review Documentation Specialist (RN)

Regional Utilization Review Documentation Specialist (RN) at TrinityHealth summary :

The Regional Utilization Review Documentation Specialist (RN) coordinates with healthcare teams and insurance payers to ensure patients receive appropriate, cost-effective care across multiple hospitals in Illinois. They conduct clinical reviews, verify authorization statuses, and manage discharge processes while adhering to regulatory and payer requirements. This role involves collaborating with physicians and administrative staff to optimize patient care delivery and support utilization management initiatives.

Employment Type : Full time Shift :

Day Shift

Description :

Utilization Review- RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal Hospitals.

Utilization Review- RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal Hospitals.

• Position will be responsible for Gottlieb Memorial Hospital, Loyola University Medical Center, and MacNeal Hospital. Office location is Loyola campus. Position is hybrid, must reside in Illinois.

The Regional Utilization Review Documentation Specialist nurse works with the multidisciplinary team including physicians, staff and payers to ensure patient's progress along the continuum of care in an efficient and cost-effective manner that ensures quality outcomes. They utilize established guidelines to support appropriate level of care throughout hospitalization. They serve as a liaison between the hospital and external payers on issues related to severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services. This position will reflect a regional coverage. The position includes but not limited to basic UR job duties such as level of care determination, clinical submission to payers, timely following / securing of auth payer status, timely discharge notification, monitoring status of procedural cases and submitting / monitoring post acute authorization status.

Admission and Concurrent Case Review :

Regulatory and Contractual Compliance :

We offer our employees :

Our Promise to You :

Joining Loyola Medicine is being a part of an organization that treats the human spirit in our patients and in our colleagues. We are a part of a community which believes in giving back to those we serve.

We seek colleagues with :

Pay Range : $78,540.80 - $121,721.60 per year

Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.

Trinity Health Benefits Summary

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Keywords :

utilization review, registered nurse, clinical documentation, patient care coordination, insurance authorization, discharge planning, healthcare compliance, case management, hospital utilization, payer liaison