RN-Utilization Review (S)

SSM Health

1d • Remote

About The Position

It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: Eligible candidates must reside within SSM Health's four state footprint - including Missouri, Illinois, Wisconsin or Oklahoma only. Job Summary: Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.

Requirements

• Graduate of accredited school of nursing or education equivalency for licensing
• Two years’ registered nurse experience
• State of Work Location: Illinois Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
• State of Work Location: Missouri Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration
• State of Work Location: Oklahoma Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
• State of Work Location: Wisconsin Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Responsibilities

• Discusses with payor regarding criteria and payor decision.
• Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration.
• Documents outcome in electronic medical record.
• Participates with other members of team regarding opportunities for improvement in standard work.
• Performs review of pre-admission, perioperative, and post operative surgical cases.
• Performs other utilization management tasks as assigned.
• Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.
• Performs other duties as assigned.

Benefits

• SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed