+ DESCRIPTION OF POSITION + Ensures that quality clinical services and financial outcomes are achieved within established time frames for assigned patients. Coordinates the plan of care with the physicians, nurses and other health care professionals from admission through the discharge of the patient. Facilitates judicious use of hospital resources. Monitors physician clinical documentation for content and completeness to assure it accurately reflects and substantiates the patient's diagnosis and procedures. Performs admission, concurrent and retrospective reviews for medical necessity for hospitalization using evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure requirements and reviews relevant charts for compliance. Responsible for providing the clinical information required by insurance providers to ensure appropriate reimbursement for services provided to patients. Role includes accessing medical records to perform ongoing performance improvement audits. + QUALIFICATIONS + Professional/Educational + Bachelor's degree required in a healthcare related field. + Case management certification preferred (e.g. CCM, ACM, CPUM). + Minimum of 3-5 years clinical experience in acute hospital setting. + Strong clinical expertise. + Prior experience in utilization management or case management preferred. + Ability to maintain proficiency in the use of hospital information systems (i.e., McKesson, Microsoft Word/Excel, Meditech, Midas, etc.) to enter and access information and record data. + General knowledge of state and federal regulatory requirements and payer/reimbursement methodologies. + Licensure as Registered Nurse in Illinois. + DCFS Mandated Reporter Certificate of Completion required. + Personal + Ability to communicate effectively in English, both verbally and in writing. + Excellent negotiation skills with physicians and others to ensure patient receive appropriate and timely care. + Work requires excellent interpersonal skills and the ability to maintain composure in difficult situations. + Able to do manage multiple tasks in an organized manner; high degree of flexibility required. + Self -directed learner; enthusiastically seeks ways to improve patient care and motivate others to participate in improvement activities. + Possesses leadership skills and knowledge of hospital operations. + Participates in training and orientation of new employees, as directed by manager. + Communicates effectively with physicians, patients and families, and all care providers. + Possesses advanced conflict resolution skills. + Ability to work independently and be self-directing. Actual pay will be determined by qualifications, experience, and internal equity. Morris Hospital & Healthcare Centers offers a comprehensive benefit package including: + Medical, dental, vision plans + Paid time off + Retirement plan, including immediate 100% vesting + Life insurance + Disability coverage + Nurse residency program + Wellness program + Health club / gym membership reimbursement + Reward & Recognition programs + Tuition Reimbursement + Employee Assistance Program https://www.morrishospital.org/careers/employee-benefits/#medical--dental--vision-and-flexible-spending-account