RN - Utilization Review Job

Full Job Title: Utilization Review RN

Job Number: 17001117

Facility: SSM Health Saint Louis University Hospital

Location: St. Louis, MO

Schedule: Per Diem

Hours: 8:00AM-4:30PM

Description

SSM Health Saint Louis University Hospital
Utilization Review Representative RN
PRN, Days

The Utilization Review Representative RN is responsible for securing insurance authorizations for all patients who have been admitted to an SSM hospital in the St. Louis Network. This is done by providing payers the necessary clinical information they require, and doing this within the timeframes specified by each payer. UR Rep RN reviews all patient records for those patients admitted to a hospital bed (inpatient or outpatient) for medical appropriateness, upon admission and throughout the stay, as outlined by nationally recognized admission criteria sets as specified by each payer.

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Qualifications

Graduate of RN program from accredited school required. BSN preferred.

- Current State of Missouri License.

- CPR required.

- 5 years med-surg/critical care experience required.

- 2-3 years of hospital case management experience preferred.

- Knowledge of case management and resources; knowledge of DRG, health care finance and third party payment

methods.

- Should be proficient in data entry, phone management, small group presentation and basic computer skills.

- Excellent verbal/written/organizational skills; able to work independently and as part of a team.

SSM Health Saint Louis University Hospital is an Equal Opportunity and Affirmative Action Employer. Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Learn More »


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