Utilization Management/Clinical Documentation Nurse In Illinois Job Details

Department: Case Management
Category: Nursing
Schedule: Full Time
Shift: Days
Hours: 8:00a.m.-4:30p.m./weekends as needed

Basic Function:  The Utilization Management/Clinical Documentation Nurse 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.  Provides clinical knowledge and data collection for quality improvement initiatives.  The Utilization Management/ Clinical Documentation Nurse plays a significant role in optimizing appropriate reimbursement for acute care services. 

Specifications, Knowledge, Training, Work Experiences, and Physical Effort: 

1. Current RN licensure in the State of Illinois required. 


2. CPR certification.


3. Minimum of 2 years of recent acute care nursing experience required.


4. Understanding of healthcare reimbursement mechanisms preferred.


5. 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: 10/01/2010