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
SSM Health Saint Louis University Hospital
Utilization Review Representative RN
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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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
- 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.
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