RN-Utilization Review (S), MO

Remote, USA Full-time
R182274 It's more than a career, it's a calling. MO-REMOTE Worker Type: Regular 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. Job Responsibilities and Requirements: PRIMARY 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. EDUCATION • Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE • Two years’ registered nurse experience REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 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 Work Shift: Day Shift (United States of America) Job Type: Employee Department: 8700010033 System Optimization Scheduled Weekly Hours: 40 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. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more. 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. Apply tot his job
Apply Now

Similar Jobs

Registered Nurse - Green Card Sponsorship for RNs (RC1)

Remote, USA Full-time

Quality Assurance Nurse (RN) Aleca Home Health AZ (Remote) Part Time

Remote, USA Full-time

Registered Nurse Care Manager

Remote, USA Full-time

Registered Nurse RN (No direct care, assessments only)

Remote, USA Full-time

Registered Nurse/ ER/ RN/ Remote Triage

Remote, USA Full-time

Seasonal Warehouse Worker - Package Handler – Amazon Store

Remote, USA Full-time

**Experienced Remote Chat Support Specialist – Flexible Work from Home Opportunity**

Remote, USA Full-time

**Experienced Customer Support Specialist – Remote Chat Support Role with Immediate Hire Opportunities at blithequark**

Remote, USA Full-time

**Experienced Digital Chat Support Representative and Customer Service Expert – Flexible Remote Work Opportunity at blithequark**

Remote, USA Full-time

**Experienced Full Stack Live Chat Operator – Remote Customer Support for blithequark**

Remote, USA Full-time

Experienced Remote Data Entry Clerk / Administrative Assistant - Part-time with Competitive Pay, Comprehensive Benefits, and Growth Opportunities at Blithequark

Remote, USA Full-time

975- Principal Cloud Consultant (AWS)

Remote, USA Full-time

**Experienced Full Stack Customer Support Advocate – Web & Cloud Application Development**

Remote, USA Full-time

**Experienced Account Manager – E-commerce Growth and Market Development at arenaflex**

Remote, USA Full-time

Experienced Customer Support Specialist - Apple Home Advisor Role with Global Impact

Remote, USA Full-time

**Experienced Full Stack Data Entry Specialist – Web & Cloud Application Development**

Remote, USA Full-time

Experienced Remote Data Entry Clerk – Part-Time Work from Home Opportunity for Detail-Oriented Individuals with Strong Typing Skills and Excellent Organizational Abilities

Remote, USA Full-time

Part Time Crew Member Including Overnights

Remote, USA Full-time

Portfolio Manager - Infection Prevention

Remote, USA Full-time

Senior Lead Business Execution Consultant, Branded Card Risk Programs

Remote, USA Full-time
Back to Home