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Surgical Clinical Reviewer-RN

Company: Advocate Health Care
Location: Elgin
Posted on: March 22, 2020

Job Description:

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

Full TIme

Days

Purpose:
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.

Accountabilities:
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 action plans.
Maintains integrity of data bases, and measures outcomes for performance improvement.
Responsible for development and professional growth and practice.

Position Requirements:
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 Illinois

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 Christ.

Keywords: Advocate Health Care, Elgin , Surgical Clinical Reviewer-RN, Healthcare , Elgin, Illinois

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