**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, 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 + 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:** 8746030033 Sys Utilization Management **Scheduled Weekly Hours:** 40 _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. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)