Job Description

At Insight Hospital and Medical Center- Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now!

GENERAL SUMMARY:

Seeking a fulltime candidate to work remotely overnight as a Utilization Review Nurse in the ER. Responsibilities include screening admissions, critical thinking, and being in constant communication with the ER Physicians.

These duties are to be performed in a highly confidential manner, in accordance with the mission, values and behaviors of Insight Hospital and Medical Center. Employees are further expected to provide a high quality of care, service, and kindness toward all patients, staff, physicians, volunteers and guests. 

• Under the direction of the UR/CM/CDI Director, the Nurse Manager has the functional responsibility for insuring clinical profiles are sent to the payers in a timely manner and that discharge planning begins in the first 24 hours of the patient’s inpatient encounter.
• He/she is responsible for team and individual development, utilization of human, technical and material resources and quality improvement activities at the unit and organization level.
• The Nurse Manager assists the director in fiscal responsibilities.
• Responsible for evaluating and screening potential admissions to the facility when appropriate.
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Communicate daily with admissions personnel regarding admissions and discharges to various units.
• Initiate ongoing communication with the resident and resident’s family to assess discharge needs.
• Communicate with physicians to ascertain their plans for a timely discharge.
• Document discharge planning as an ongoing review.
• Knowledgeable of resident’s financial status, diagnosis and discharge needs.
• Responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
• Cooperate with insurance companies, based on information received.
• Manage and collaborate with the healthcare team on ED Hold Bed placement and complete clinical documentation as necessary.
• Assist as needed with obtaining referrals, prior authorization for Home Health Care and DME for home use by the patient.
• Educates physicians and staff regarding appropriate level of care/utilization issues.
• Develop and implement methods, policies and procedures to improve the departments’ efficiency and overall effectiveness.

• Registered Nurse
• Available to work nights
• Experience with UR/ Case Management (Preferred)

Insight is an equal opportunity employer and values workplace diversity!

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