LOCATION: STROGER HOSPITAL/INTEGRATED CARE - CHICAGO, IL
SHIFT: 8:00 AM - 4:00 PM
Organizes and communicates clinical information about a patient's condition, proposed procedure or need for ongoing services to support medical necessity review, prior to the procedure being performed to support Cook County Health and Hospitals System (CCHHS) reimbursement. Prior authorization nurse supports a proactive discharge process with early identification of patients at risk for poor discharge outcomes.
Must be licensed as a Registered Professional Nurse in the State of Illinois.
A minimum of two (2) years of work experience in a Medical/Surgical setting is required .
A minimum of one (1) year of experience in Utilization Management working for a physician group, insurance company or management services organization is required .
Prior experience using InterQual or Milliman criteria sets is required.
Bachelor's degree in Nursing or health related field is preferred.
Minimum of one (1) year of experience with Electronic Medical Record (EMR) is preferred.
Prior case management and/or medical insurance experience is preferred.
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question,
The Cook County Health & Hospitals System’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCHHS is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCHHS is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, collaborative health plan and enhancing the patient experience.