Demo

Emergency Room Utilization Review Nurse/Case Manager

Silver Cross Hospital
Lenox, IL Full Time
POSTED ON 2/22/2025
AVAILABLE BEFORE 5/17/2025

Silver Cross Hospital is an extraordinary place to work. We're known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve...and for each other. Come join us! It's the way you want to be treated.

Position Summary : Assesses and coordinate care for diverse group of patients. Actively collaborating with a multidisciplinary health care team / patient and family to ensure safe coordination of care; performs utilization review functions to aide in the determination of correct patient status for those being admitted thru the emergency room

Essential Duties and Responsibilities :

  • Serves as gatekeeper by screening patients for admission; establishing level of care; offers alternatives for admission; communicates with care providers; reviews documentation
  • Works collaboratively with social service team members to address Social Determinants of Health needs
  • Collaborates with physicians, emergency as well as admitting providers to assess appropriate level of care
  • Serves as a resource to assist documentation improvement efforts
  • Collects information from clinical medical record for severity of illness and intensity of service and documents such in clinical data base
  • Monitors all levels of care for appropriateness and communicates variance; evaluates plan of care to ensure it is based on accepted standards
  • Provides information to external review organizations, documents pertinent communications
  • Refers to designated physician advisor those patients not meeting criteria as well as quality of care concerns
  • Maintains knowledge and incorporates current standards into practice
  • Provides the highest standard of privacy and confidentiality in matters involving patients, coworkers, and the hospital by abiding by the Standards of Conduct

Required Qualifications :

Education and Training :

  • Currently licensed as a Registered Nurse in the state of Illinois.
  • BSN preferred. 2-5 years previous Utilization Review experience preferred.
  • Current CPR
  • Relevant hospital nursing; hospital case management; insurance case management or utilization management experience preferred
  • Self directed; creative problem solver; Leadership abilities; Excellent communicator
  • Work Shift Details :

    Days - First Shift, Hours : 11am-7 : 30 pm M-F initially, rotating weekend and holiday anticipated in the future

    Department : CONTINUUM OF CARE

    Benefits for You

    At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.

    Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes :

  • Medical, Dental and Vision plans
  • Life Insurance
  • Flexible Spending Account
  • Other voluntary benefit plans
  • PTO and Sick time
  • 401(k) plan with a match
  • Wellness program
  • Tuition Reimbursement
  • Silver Cross Management Services Org. - Premier Suburban Medical Group benefits offered to Full-time and Part-time employees include :

  • Medical, Dental and Vision plans
  • Life Insurance
  • Health Savings Account
  • Flexible Spending Account
  • Other Voluntary benefit plans
  • PTO bank
  • 401(k) plan with a match
  • Wellness program
  • Tuition Reimbursement
  • Registry employees who meet eligibility may participate in one of our 401(k) Savings plan with a potential match. However,registry employees are ineligible for Health and Welfare benefits.

    The expected pay for this position is listed below :

    34.73 - $45.15

    The final offered salary will take several factors into consideration, including but not limited to : licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.

    Salary : $35 - $45

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