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

Associate Optometrist (Remote) Louisiana (Monroe, Louisiana, 71203)

Remote, USA Full-time

Optometrist, Part-Time - Brooklyn

Remote, USA Full-time

Optometrist - North Hills

Remote, USA Full-time

Optometrist-Cleveland, OH-Target Optical in Cleveland, OH

Remote, USA Full-time

Hybrid Optometrist (Clinical)

Remote, USA Full-time

Experienced Full Stack Customer Service Representative – Remote Chat Support Specialist

Remote, USA Full-time

Junior Tech Support Specialist (24/7 Live-Chat Team) for blithequark

Remote, USA Full-time

Virtual Chat Support Specialist – Deliver Exceptional Customer Experiences from the Comfort of Your Own Home

Remote, USA Full-time

Experienced Live Chat Customer Service Representative – Remote Opportunity with blithequark

Remote, USA Full-time

Experienced Live Chat Support Representative – Delivering Exceptional Customer Experience in Waterproofing Solutions

Remote, USA Full-time

Operations and Fulfillment Analyst- bolthires Healthcare - Remote

Remote, USA Full-time

Experienced Remote Data Entry Specialist – Entry-Level Full-Time Opportunity for Career Growth and Development in the United States

Remote, USA Full-time

Experienced Student Customer Service Representative – Online Support and Service Delivery Expert

Remote, USA Full-time

Education, Training, and Outreach Specialist (100% Remote) in USA

Remote, USA Full-time

RN Utilization Management Nurse MST or EST Preferred – Remote

Remote, USA Full-time

flex jobs at Amazon Flex

Remote, USA Full-time

Experienced Live Chat Assistant – Delivering Exceptional Customer Service in a Dynamic Remote Environment

Remote, USA Full-time

Community Health Clinical Nursing Faculty (Part-Time) in Pearland, TX in Chamberlain University (job Id: 1690498219)

Remote, USA Full-time

Experienced Virtual Customer Service Representative – Remote Part-time Opportunity for Exceptional Customer Experience Professionals at blithequark

Remote, USA Full-time

Experienced House Cleaner for Airbnb Turnovers

Remote, USA Full-time
Back to Home