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Registered Nurse - Utilization Review at Loyola Medicine - ApplyBlast

Registered Nurse - Utilization Review

Loyola Medicine

5 months ago

3.1 on Glassdoor

Remote

Part Time

Junior

0 applicants

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About this role

This is a part-time, remote Utilization Review role with mandatory onsite training in Mishawaka, Indiana. The position involves conducting clinical reviews of patient records to evaluate medical necessity, compliance, and appropriate resource utilization across various payor types. Candidates will collaborate with interdisciplinary teams, manage denials, and work closely with healthcare providers to ensure proper discharge planning and reimbursement processes.

Responsibilities

Conduct clinical reviews of patient records for medical necessity
Apply regulatory guidelines to support reimbursement and compliance
Collaborate with physicians and nursing staff on care planning
Manage denials and authorization changes for accurate documentation
Identify utilization trends to support quality improvement initiatives

Skills

Qualifications

Registered Nurse (RN)Bachelor's Degree in NursingActive RN License

About Loyola Medicine

loyolamedicine.org

Headquarters

Maywood, Illinois, United States

Company Size

5001-10000 employees

View Profile

Loyola Medicine is a not-for-profit health system providing comprehensive medical care across its hospitals and outpatient facilities in Illinois, including Loyola University Medical Center, Gottlieb Memorial Hospital, and MacNeal Hospital. The organization offers urgent and specialty care, telehealth visits, online scheduling, patient portal access (MyChart), and streamlined access to medical records and billing.