Utilization Review Registered Nurse

BJC HealthCare • St. Louis, MO

2d • 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.). The purpose of this role 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. This role will evaluate the cost and quality of medical services provided by the medical team. It will ensure appropriate utilization, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation. This role also involves the education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources.

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.
• Nursing Diploma/Associate's - Nursing
• 2-5 years experience
• 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.

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