Utilization Review Nurse Jobs in Decatur, IL (NOW HIRING)

The Clinical Manager (Registered Nurse/RN) ensures that the overall coordination of hospice services provided to the patient is delivered according to acceptable standards of practice and all company procedures. This position reviews and approves patient information submitted by the licensed professional (LP), assists with patient care review meetings (IDG), the review and approval of orders, and provides oversight of patient care, and is responsible for assisting the branch director with day-to-day office and staff management related to patient care.
The Care Team in partnership with Traditions Healthis seeking a new Clinical Team Manager RN to join our growing Hospice Team in Decatur, IL!
About Us: Traditions Health is a leading provider of hospice, home health and palliative care. The company provides care to over 8,500 patients across 19 US states. The company has recently been named to the 2021 Inc. Magazine's "Inc. 5000" list of fastest-growing businesses. As the company continues to expand across the country, Traditions Health remains committed to the same values on which it was founded: focusing on providing patient-focused, compassion-driven care while building strong relationships in the communities it serves.
What Can Traditions Health Offer?

• Work/Life Balance
• Career Advancement Opportunities
• Competitive Pay and Benefits
• Supportive Senior Staff
• Autonomy
• More Time to Care for Your Patients
• Engaging Company Culture
• Competitive Compensation and Excellent Benefits
• Growth from within through training, supportive leadership, and collaboration with the best of the best in your field

KEY JOB RESPONSIBILITIES: The Clinical Manager (Registered Nurse/RN) ensures that the overall coordination of home health and/or hospice services provided to the patient is delivered according to acceptable standards of practice and all company procedures. This position reviews and approves patient information submitted by the licensed professional (LP). This position assists with patient care review meetings (Case Conference and Interdisciplinary Team (IDT)), the review and approval of orders, and provides oversight of patient care. The Clinical Manager is responsible for assisting the branch director with day-to-day office and staff management related to patient care. This position assists the branch leadership with ongoing education and training of all branch clinicians to ensure understanding of documentation requirements to meet regulatory standards. The Clinical Manager (Registered Nurse/RN) facilitates the relationship between physicians, referral sources, patients, caregivers, and employees.
Additionally, the Clinical Manager (Registered Nurse/RN) will:

• Clinical Manager (Registered Nurse/RN) review on call coordination notes reports daily.
• Communicate with patients and their families to introduce TCT, discuss services to be rendered, and inform them of the potential start of care visit date: follow back up with the sales team member, as needed.
• Clinical Manager (Registered Nurse/RN) provide educational material for family and staff on medical diagnoses, provision of care, and psychosocial aspects of chronic illness and disability, and end of life care.
• Assist with maintaining provider requirements; work with providers, sales, and clinical staff to resolved issues, as appropriate.
• Clinical Manager (Registered Nurse/RN) process workflow, coordination notes, and administrative tasks timely.
• Back up the intake coordinator to receive and enter referrals from payors, physicians, facilities, and staff; clearly identify who obtained the referral.
• Clinical Manager (Registered Nurse/RN) attach referral paperwork to medical record timely, as needed.
• Communicate acceptance of referrals clearly with referral sources, as needed.
• Clinical Manager (Registered Nurse/RN) back up the Patient Service Coordinator (PSC) to reschedule missed and declined visits, and process reassigned and rescheduled requests to ensure timely completion.
• Review patient schedules and approve schedule changes to ensure clinical skills of assigned staff meet patient requirements.
• Clinical Manager (Registered Nurse/RN) follow up on orders, as needed, when medical records is unable to retrieve the unsigned order.
• Remain up to date on internal information announcements and ensure TCT policies and procedures, critical pathways, standards of care, and practice guidelines are met.
• Clinical Manager (Registered Nurse/RN) provide orientation and in-service training to field and office staff to meet patient needs, particularly with documentation standards, track and document education appropriately.
• Assist the Branch Director and administrator during any survey, as directed.
• Clinical Manager (Registered Nurse/RN) attend and participate in staff meetings and in-services.
• Attend and participate in community education functions.
• Clinical Manager (Registered Nurse/RN)address action items and rocks to ensure that TCT is able to accomplish their important goals.
• Participate in administrative on-call; support the on-call nurse and provide software management related to processing intake and crucial workflow during off hours.
• Conduct continuous quality assessment and performance improvement activities, as assigned.
• Complete onsite supervisory visits, as assigned.
• Assist with the day-to-day supervisor of branch clinical operations.
• May assume a position of leadership when the branch director is out of the office; perform supervisory tasks, such as evaluations and counseling, or make hiring and termination recommendations for branch and field staff, as requested.
• Responsible for the referral intake and management process to ensure patients receive assessment visits, scheduled and performed timely by TCT policy.
• Assist branch director with patient review meetings (case conference and IDT); address care decisions based on review.
• Review and approve patient care assessment coordination notes submitted by case managers and attach to episode detail report. Contact physicians to obtain orders for continued service provision or add on services, as needed.
• Review and approve all patient information submitted by the licensed professional (LP).
• Review orders as written by clinicians; approve or decline as appropriate. Follow up with licensed professional (LP), as necessary, when editing and order.
• Ensure all orders are complete, including frequency, and that any corrections are made by the licensed professional who wrote the order, prior to approving the order; complete any follow up tasks as deemed necessary, by order.
• Enter and approve all orders; route to medical records to be sent for physician signature.
• Ensure that there are existing orders for requested medical supplies.
• Enter detailed non-admit information into patient record in coordination notes if no visit was made; ensure the branch director is informed approve the non-admission.
• Review and process all wound score deviations, documenting any action and follow up.
• Review and process vital sign alert reports; document follow-up action and physician notification.
• Receive lab reports and assess for normality; fax lab report to the physician with signature indicating review. Scan both the reviewed labs and the fax confirmation page (showing it was sent to physician) to medical records for uploading into the patient chart.
• Initiate employee and patient infection reports, as necessary.
• Complete review of evaluation documentation and plans of care (POC). Review the data submitted to ensure accuracy with the POC; follow up on any documentation that requires correction.
• Process POC and verify the correct start of care date.
• Review comprehensive assessments that cannot be processed due to licensed professional documentation deficiencies; follow up appropriately.
• Perform and maintain ongoing chart audits according to standard operating procedure.
• Assist with hospice item set data, as requested; review every error message and to seek guidance from the branch director prior to locking.
• May perform all duties and visit expectations of a licensed professional, as needed.
• May participate in on-call rotation, as needed.
• Any additional duties assigned by supervisor.

Registered Nurse RN Registered Nurse RN Registered Nurse RN Registered Nurse RN Registered Professional Experience Qualifications:

• Previous experience in Home Care Home Base (HCHB) is preferred. Advance computer skills are preferred.
• Must be organized, detail oriented, and able to manage multiple projects simultaneously.
• Must be able to work independently with minimal supervision and possess the ability to communicate effectively, both in orally and in writing.
• Must be a self-starter with the ability to work effectively independently and as a team.
• Must possess a high standard of professional ethics.
• Must possess a passion for helping patients.
• Must have strong ability to maintain a professional and friendly demeanor in a high stress environment with a broad range of individuals and demonstrate a service-oriented attitude.
• Must understand the issues related to the delivery of home health care and be able to problem-solve effectively.
• Must comply with accepted professional standards and practices.
• Maintains the agency's mission, philosophy, and core values.
• Ensures compliance with agency policies and procedures regarding operations/processes, including but not limited to those regarding patient care, patient complaints, incidents, safety and emergency management.
• Ensures compliance with policies and procedures regarding infection prevention, control, standard precautions, and infection identification reporting.
• Always maintains patient confidentiality, including all HIPAA regulations.
• Attends QAPI and management meetings, as appropriate.

Education:

• Graduate of an accredited School of Nursing.
• Bachelors Degree in Nursing preferred.
• Two years as a Registered Nurse with at least one-year management experience in a home care, hospice or equivalent environment required.

Regulatory requirements:

• Must be licensed as a registered nurse (RN) in the state where they currently practice, or in accordance with the board of nursing rules for nurse licensure compact for the state where they currently practice.
• Must pass a criminal background check & MVR check.
• Completed health statement acknowledging ability to perform the duties of the position.
• Valid state drivers license.
• Must maintain automobile liability insurance as required by law.
• Current CPR card.
• TB testing per agency policy; (1 or 2 step TB skin test within 12 months of hire & annual TB symptom screening thereafter).

Traditions Health is highly invested in not only your overall health, but also your future. This is reflected in the benefits we provide and the opportunities we make available to our employees. Benefits for eligible employees include:

• Full range of health insurance-medical (BCBS with 3 medical plan options), dental & vision.
• Health Savings Account with employer contribution
• Company sponsored life insurance
• Supplemental life insurance
• Short and long-term disability insurance
• Accident & Critical Illness
• Employee Assistant Program
• Generous PTO (that increases with your tenure)
• 401(k) Retirement Plan with Employer Match
• Mileage reimbursement
• Continuing education opportunities

We aspires to maintain a market competitive, internally equitable, and performance-based rewards program in order to attract, retain, and motivate employees. This philosophy includes to pay commensurate with experience, skills, competencies, and individual performance.
Traditions Health is becoming The Care Team, aligning with a leading provider of hospice care, committed to providing the best possible care to their patients and families, and employees. Candidates selected for this position will transition to employment with The Care Team effective January 1, 2026. You will have the opportunity to contribute to meaningful work, supported by The Care Team values, resources, and commitment to caring for the communities we serve.
At The Care Team, our purpose has always been clear: to deliver exceptional hospice care that brings comfort, dignity, and peace to patients and their families wherever they call home. Since our founding in 2015, we have grown to be a leading provider of hospice services in Michigan, with locations throughout the state and additional presence in Indiana and Pennsylvania. Our exceptional Care Team members are the heart of what we do and include incredible nurses, medical social workers, aides, chaplains, and dedicated volunteers who work together to support both patients and their families. We believe that every person deserves to be cared for with compassion, respect, and excellence during life's most tender moments. That belief is what unites us and makes our work so meaningful. For more information, visit tctcares.com
Careers: We are always looking for Top Talent to join our trusted team at Traditions Health, where you will make a difference in the lives of your patients, co-workers, and the communities you serve. Apply now to connect with a recruiter to learn more about our opportunities.
Compensation Range:
$86,900.00 - $102,700.00
Traditions Health is highly invested in not only your overall health, but also your future. This is reflected in the benefits we provide and the opportunities we make available to our employees. Benefits for eligible employees include:

• Full range of health insurance-medical (BCBS with 3 medical plan options), dental & vision.
• Health Savings Account with employer contribution
• Company sponsored life insurance
• Supplemental life insurance
• Short and long-term disability insurance
• Accident & Critical Illness
• Employee Assistant Program
• Generous PTO (that increases with your