RN - Utilization Review - SSM Health : Job Details

It's more than a career, it's a calling

WI-REMOTE

Worker Type:

Regular

Job Highlights:

Department: Utilization Review​

Schedule: Full Time, Day Shift​

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 5 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:

Employee

Department:

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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.

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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. (