[Hiring] RN-Utilization Review @SSM Health

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves evaluating the medical necessity and appropriateness of hospital admissions and surgical procedures. • 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. • Participates with other members of team regarding opportunities for improvement in standard work. • Performs review of pre-admission, perioperative, and post operative surgical cases. • Performs other utilization management tasks as assigned. • Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice. • Ensures that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service. • Performs other duties as assigned. Qualifications • Graduate of accredited school of nursing or education equivalency for licensing • Two years’ registered nurse experience Requirements • Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) • Registered Nurse (RN) Issued by Compact State (Missouri) • Registered Nurse (RN) - Missouri Division of Professional Registration • Registered Nurse (RN) Issued by Compact State (Oklahoma) • Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) • Registered Nurse (RN) Issued by Compact State (Wisconsin) • Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services Benefits • Paid Parental Leave: one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). • Flexible Payment Options: instant access to earned, unpaid base pay through DailyPay (fees may apply). • Upfront Tuition Coverage: upfront tuition coverage through FlexPath Funded for eligible team members. Apply tot his job