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Utilization Review Nurse at Loyola Medicine - ApplyBlast

Utilization Review Nurse

Loyola Medicine

2 months ago

3.1 on Glassdoor

Fort Lauderdale, Florida, United States

Hybrid

Full Time

Medior

0 applicants

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About this role

The Utilization Review Nurse ensures appropriate admission status and level of care for hospitalized patients by conducting chart reviews, supporting authorizations, and coordinating discharge planning in compliance with MCG/InterQual criteria, CMS regulations, and payer requirements. The role works closely with physicians, case management, and external payers, utilizing Epic or similar EMR systems.

Responsibilities

Conduct chart reviews to confirm admission and level‑of‑care criteria
Provide clinical reviews to external payers for authorization decisions
Collaborate with physicians, advisors, case management and payers for discharge planning

Skills

About Loyola Medicine

loyolamedicine.org

Headquarters

Maywood, Illinois, United States

Company Size

5001-10000 employees

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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.