RN - Resource Management Nurse Reviewer

Employment Type:

Full time

Shift:

Day Shift

Description:

At MercyOne, health care is more than just a doctor’s visit or a place to go when you’re in need of medical attention. Our Mission is based on improving the health of our communities – that means not only when you are sick but keeping you well.
MercyOne Genesis serves a 17-county bi-state region of the Quad Cities (Davenport and Bettendorf, Iowa, and Rock Island and Moline, Ill.) metropolitan area and the surrounding communities of Eastern Iowa and Western Illinois. But when it comes to clinical capabilities and quality, we exceed those geographical limits. We have earned distinction as a two-time national Top 15 Health System, and recognition for being in the top 1 percent in the nation for patient safety.

We are looking to hire a Resource Management Nurse Reviewer to join our Care Coordination team!

Schedule:

• Monday-Friday, 0800-1630

Responsibilities:

•  Monitors patient information to assess documentation of medical necessity for appropriate level of care and ensure benefit utilization to maximize reimbursement
• Provides education to healthcare personnel and physicians relative to care status, resource utilization, documentaion requirements, optimization opportunities, and appropriate levels of care
• Key accountabilities include:  evaluating medical necessity for level of care, making referrals to physician advisor as indicated, ensuring benefits are utilized according to individual insurance plans and payor contracts
• Identifying and tracking inappropriate resource utilization and delays in discharge, ensuring documentation supports coding/DRG assignment, reviewing overnight outpatient and observation patient documentation

General Requirements:

• Training Preferred: ICD Coding knowledge, InterQual Criteria
• Licensure/Registration: Registered Nurse in Iowa or Illinois required upon hire. Second state license required in 6 months.
• Experience: More than 5 years experience required

Education:

• Education: 2 year college program or equivalent experience
• Field Of Study: Nursing

Colleagues of MercyOne Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout the system!

 

Visit MercyOne Careers to learn more about the benefits, culture, and career development opportunities available to you at MercyOne Health System circle of care.

 

Want to learn more about MercyOne Genesis? Click here: MercyOne Genesis | Stronger. Together. As One!

Davenport/Quad Cities

Davenport and the Quad Cities region combine affordability with vibrant culture. Families benefit from the Davenport Community School District and nearby colleges like St. Ambrose University and Augustana College. The area offers museums, riverfront parks, bike trails and year-round festivals, plus easy access to Chicago and Des Moines for weekend trips.

MercyOne Genesis Davenport Medical Center, established in 1869, is one of the largest employers in the Quad Cities, with a workforce of nearly 5,000 employees. The non-profit regional health system has 674 licensed beds and more than 70 locations, serving a 17-county bi-state region of the Quad Cities in eastern Iowa and western Illinois. It offers NICU, cancer, cardiac, robotics, critical care, pediatrics, women’s health, surgical, emergency, stroke, imaging, lab and weight‑management services. Recognition includes IBM Watson top‑15 health system, Leapfrog “A” safety grade, U.S. News top‑ranked hospital, national quality leadership, IT Most Wired, nursing excellence designations and Great Iowa Nurse honorees.

Silvis

Silvis offers affordable living and access to the East Moline School District and nearby colleges in the Quad Cities. Families enjoy local parks, libraries and recreation facilities, plus proximity to cultural attractions and events in Davenport and Moline.

MercyOne Gensis Silvis Medical Center is a 150‑bed full‑service acute care-center serving a three‑county region in Illinois, offering 24/7 emergency, ambulance, ICU/critical care, birth center, heart and vascular, diabetes, imaging, lab, orthopedics, pharmacy, physical therapy, sleep, stroke and surgical care.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.