Utilization Review Nurse

Job description Position: Utilization Review Nurse (UR) Status: Full-time Location Polk Street Center - 1634 West Polk Street, Chicago, IL 60612 Who we are: Union Health Service (UHS) is an AAAHC (Accreditation Association for Ambulatory HealthCare) accredited non-profit multi-specialty managed care plan covering approximately 48,000 Chicago area union members and their dependents since 1955. UHS has approximately 50 primary care physicians, over 70 specialist physicians and a tremendous clinical and support staff at 6 different medical facilities. UHS is proud to be an employer that has a diverse workforce – boasting multi-language skills across the organization, merging different cultures and heritage – a proven strategy that comes with a long history of people who have stayed in the company for many years. We have an average length of service of over 12 years, above industry standard employee benefits, and eighty percent of our employees are union members. Job Description: Reporting to the Director of Medical Management, the UR Nurse implements care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Responsibilities: · Function in accordance with applicable state, federal laws and regulatory compliance. · Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. · Promote quality and efficiency in the delivery of care management services. · Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. · Practice within the scope of ethical principles. · Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. · Employ collaborative interventions, which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member. · Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. · Develop and sustain positive working relationships with internal and external customers. · Utilize outcomes data to improve ongoing care management services. · Other duties as assigned or requested. QUALIFICATIONS · Active IL RN (Registered Nurse) license / Active LPN (License Practical Nurse) · 3 - 5 years of related, progressive clinical experience in the area of specialization · Experience in a clinical setting · Preferred Experience in UM/CM/QA/Managed Care Job Type: Full-time Pay: From $31.41 per hour Expected hours: 37.50 per week Benefits: • Dental insurance • Disability insurance • Employee discount • Free parking • Health insurance • Life insurance • Paid time off • Parental leave • Retirement plan • Tuition reimbursement Schedule: • Day shift • Monday to Friday Work Location: In person