Surgical Clinical Reviewer-RN
Company: Advocate Health Care
Posted on: March 22, 2020
Sherman Hospital, a Magnet recognized hospital located in Elgin,
Ill., is a 255-bed facility that features private patient rooms, a
15-acre geothermal lake, an advanced Emergency Department, a
free-standing Cancer Care Center, a spacious Family Birthing
Center, a Heart & Vascular Center and more. Sherman also provides
convenient, quality healthcare services at Sherman outpatient
centers in Algonquin, Elgin, and South Elgin.
Surgical Documentation Specialist
Sherman Hospital, Elgin
The Surgical Documentation RN Analyst is responsible for insuring
the overall quality and completeness of clinical documentation,
including appropriate level of care, and medical necessity for
scheduled inpatient and outpatient procedures. To facilitate the
modification of the clinical documentation through concurrent
interaction with physicians and their office staff. Serves as a
liaison between the hospital and payers on issues related to
indications for the procedure, medical necessity, and level of
care. Create reports identifying successes and opportunities for
improvement in service line and physician education. Obtains
authorization from payers prior to the procedure if required to
insure timeliness of the procedure. Presentation of findings to
patient care team.
Medical record review to insure appropriateness of the procedure,
medical necessity,and completeness of documentation.
Liaison function with external review agencies, internal
departments, physicians and their office staff, to insure
compliance with regulations and requirements affecting
reimbursement to the hospital.
Identifies variances from established criteria, plans of care,
pathways, algoritms, and guidelines and facilitates development of
Maintains integrity of data bases, and measures outcomes for
Responsible for development and professional growth and
BSN preferred and 2yrs of hospital nursing, surgery preferred,
hospital case management, insurance case management, or utilization
management experience or
ADN/Diploma with agreement to enroll in BSN completion program plus
3 years of hospital nursing, hospital case management, insurance
case management, or utilization management experience Knowledge of
clinical practice norms.
Excellent communication skills.
Critical thinking skills
Organization, planning, and time management skills.
Basic computer skills Current nursing license in State of
CPR Ability to work in changing environment
About Advocate Health Care
Advocate Health Care, named among the nation's Top 5 large health
systems based on quality by Truven Analytics, is the largest health
system in Illinois and one of the largest health care providers in
the Midwest. Advocate operates more than 250 sites of care,
including 12 hospitals that encompass 11 acute care hospitals, the
state's largest integrated children's network, the state's largest
emergency and Level I trauma network, one of the area's largest
home health care companies, and the region's largest medical group.
Advocate Health Care has 4 teaching hospitals and is a
not-for-profit, mission-based health system affiliated with the
Evangelical Lutheran Church in America and the United Church of
Keywords: Advocate Health Care, Elgin , Surgical Clinical Reviewer-RN, Healthcare , Elgin, Illinois
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