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Blessing Hospital UTILIZATION REVIEW SPECIALIST - REGISTERED NURSE (RN) in QUINCY, Illinois

  • JOB SUMMARY

  • Collaborates with the Clinical Care Coordinator (C3) to provide care specific clinical information to third party payers; responsible for timely provision/flow of clinical information to/from third party payer and C3 to ensure certification/approval of observation, inpatient, and post discharge services. Works collaboratively with all members of the healthcare team to improve patient throughput and length of stay performance of the organization. The Payer Placement Specialist exhibits excellence in organizational skills when managing multiple tasks at one time. It is necessary to maintain current knowledge of basic health care economics, trends, and reimbursement methodologies and apply knowledge to daily practice and continually develop professionally and apply knowledge and skills necessary to provide care appropriate to each patient. Coordinates, manages, monitors, and tracks denials.

This position requires full understanding and active participation in fulfilling the Mission of Blessing Hospital. It is expected that the employee demonstrate behavior consistent with the Core Values while supporting the strategic plan, goals and direction of the Performance Improvement Process (PIP) at Blessing Hospital.

  • JOB QUALIFICATIONS

  • Education/Training/Experience:

  • REQUIRED:

  • Graduate of an RN School of Nursing

  • Excellent written and verbal communication skills

  • Graduate of a Bachelor’s degree School of Nursing (BSN) or BSN obtained within 2 years of hire

  • PREFERRED:

  • Minimum of 3 years acute clinical experience and demonstrated competence in critical thinking

  • License/Certifications/Special Requirements:

  • Possesses current Illinois RN license.

  • Knowledge of third party reimbursement or utilization management skills plus strong knowledge of medical terminology.

  • Experience with office machines (i.e. copier, fax, telephone, scanner) computer terminal, personal computer, software (i.e. word processing, e-mail,) required.

  • Pay Status:

  • Non-Exempt Hourly

IND2

Blessing Health System provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Blessing Health System complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Blessing Health System expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Blessing Health System’s employees to perform their job duties may result in discipline up to and including discharge.

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