Utilization Review Registered Nurse

BJC HealthCare • St. Louis, MO

3d • Remote

About The Position

Join a stable work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position supports all units/staff (commercial, behavioral health, inpatient, etc.). Full-time; 40 hours per week. Monday - Friday; days; 8am-4:30pm. Assigned Sunday shifts (every 4-6 weeks). No holidays.

Requirements

• 2 years of RN experience performing care for hospitalized patients
• 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity
• Must live within one hour of the BJC Commons (4249 Clayton Ave, St. Louis, MO 63110)
• Must have high speed internet
• Must have at least one active MO or IL RN license
• If candidate only has one RN license (MO or IL), the application process for the 2nd license must be started after receiving the job offer.
• RN

Nice To Haves

• EPIC experience
• Bachelor's Degree - Nursing

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.
• 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.
• Evaluate the cost and quality of medical services provided by the medical team.
• Ensure appropriate utilization, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation.
• Education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources.

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