It's more than a career, it's a callingMO-REMOTEWorker Type:RegularJob Highlights:
Department: Utilization Review
Schedule: Full Time, Day Shift, 8:00am-4:30pm; no weekends
Starting Pay: $67,766.40+ annually (Offers are based on years of experience and equity for this role. )
Location: Remote ( candidate must live in IL, MO, OK, or WI )
Candidate must have inpatient RN experience; ICU or med surg 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 CERTIFICATIONSState 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. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?ga=2.205881493.704955970.1667719643-240470506.1667719643)