RN-Utilization Review
WI-REMOTE
It's more than a career, it's a calling
WI-REMOTEWorker Type:
RegularJob Highlights:
Department: Utilization Review
Schedule: Full Time, Day Shift, 8:30am-5:00pm; every 3rd weekend rotation
Starting Pay: $67,766.40+ (Offers are based on years of experience and equity for this role.)
Location: Remote (candidate must live in IL, MO, OK, or WI)*
*If living in MO, OK, or WI, candidate must have multistate licensure; if living in IL, candidate must have individual state licensures for all four states (IL, MO, WI, and OK).
Candidate must have prior hospital utilization review experience and 2 years inpatient RN experience (ER and ICU experience is a plus!)
Job Summary:
Ensure payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
- Reviews electronic medical record and screen clinical information with nationally recognized criteria.
- 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.
- Active participant with other members of team regarding opportunities for improvement in standard work.
- As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model.
- Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.
- 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:
EmployeeDepartment:
8746030033 Sys Utilization ManagementScheduled Weekly Hours:40SSM 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.
ApplyJob Profile
RestrictionsMO Multistate licensure required for MO, OK, WI Must live in IL, MO, OK, or WI OK WI
Benefits/PerksEqual opportunity employer Full-time schedule Remote work
Tasks- Discuss with payor
- Document outcomes
- Participate in team improvement
- Review clinical information
ANA Code of Ethics Authorization Clinical Information Electronic Medical Record Nursing Peer to Peer Consideration RN Utilization Review
Experience2 years
EducationAccredited School of Nursing Nursing Diploma
CertificationsRegistered Nurse - Illinois Registered Nurse - Missouri Registered Nurse - Oklahoma Registered Nurse - Wisconsin