It's more than a career, it's a calling
WI-REMOTEWorker Type:
RegularJob Highlights:
Department: Utilization Review
Schedule: Full Time, Day Shift, 8:30am-5:00pm; every 3rd weekend rotation
Starting Pay: $67,766.40+ (Offers are based on years of experience and equity for this role.)
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 2 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
EXPERIENCE
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
State of Work Location: Missouri
State of Work Location: Oklahoma
State of Work Location: Wisconsin
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.