Utilization Management/Clinical Doc Specialist In Illinois Job Details

Department: Case Management
Category: Nursing
Schedule: Full Time
Shift: Days
Hours: 8a-4:30p; weekends/on-call as needed

Basic Function:  The Utilization Management Clinical Doc Specialist provides prospective, concurrent, and retrospective clinical review of patient records to evaluate the need for and utilization of acute care services and to provide payors with requested information regarding patient stay.  Ensures the patient care team is aware of general length of stay requirements for all patients.  Facilitates appropriate physician documentation to accurately reflect patient severity of illness and risk of mortality/morbidity.  Specific review parameters evolve on an ongoing basis, determined both internally and by requirements of external payors or regulatory agencies.  Also provides clinical expertise and data collection for quality improvement initiatives.  The Utilization Management Clinical Doc Specialist plays a significant role in optimizing appropriate reimbursement for acute care services. 

Requirements for this position include:  1. Current RN licensure in the State of Illinois.  LPN licensure with 3-5 years of experience may be considered in lieu of RN licensure; 2. CPR certification; 3. Minimum of 2 years of recent acute care nursing experience; 4. Understanding of healthcare reimbursement mechanisms preferred; 5. Ability to project a professional, friendly, solution-focused demeanor, with strong oral and written communication skills; 6. Understanding of the principles of performance improvement, team collaboration, and conflict resolution; 7. Evidence of continuing professional development.

Date posted: 02/06/2010