Clinical Appeals RN

BJC HealthCare • St. Louis, MO

10h • Remote

About The Position

Join our team as a Clinical Appeals RN and advocate for patients in a unique way! As a remote nurse, you'll be part of an interdisciplinary team that appeals denials on behalf of each patient you support. With clinical appeals to insurance companies, you can increase patient satisfaction even after a denial has been made. BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development. BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. The role purpose is to ensure that the administration of hospital resources are appropriate, efficient and fall within the parameters of the patient's payment structure while providing safe and quality care. It also involves evaluating the cost and quality of medical services provided by the medical team, ensuring appropriate utilization (including evaluation of potential under and over-utilization), and educating medical providers and other health care professionals on the appropriate and cost-effective use of health care resources.

Requirements

• At least 1 year of Utilization Review, Case Management, and/or Clinical Appeals experience
• Nursing Diploma/Associate's degree in Nursing
• 2-5 years of experience
• RN license

Nice To Haves

• At least 2-3 years of hospital-based RN experience
• Bachelor's Degree in Nursing (BSN)
• Prior experience with EPIC

Responsibilities

• Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care.
• Uses Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting.

Benefits

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 251-500 employees