[Hiring] Utilization Review Registered Nurse @BJC HealthCare

Role Description This role involves ensuring that the administration of hospital resources is appropriate, efficient, and falls within the parameters of the patient's payment structure while providing safe and quality care. • Evaluate the cost and quality of medical services provided by the medical team. • Ensure appropriate utilization, including the evaluation of potential under and over-utilization according to patient's presentation and documentation. • Educate medical providers and other health care professionals on the appropriate and cost-effective use of health care resources. • Use clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care. • Use Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting. Qualifications • Nursing Diploma/Associate's in Nursing • 2-5 years of experience • No supervisory experience required • Active RN license Requirements • 2 years of RN experience performing care for hospitalized patients • 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity • Must live within one hour of the BJC Commons (4249 Clayton Ave, St. Louis, MO 63110) • Must have high-speed internet • Must have at least one active MO or IL RN license • If candidate only has one RN license (MO or IL), the application process for the 2nd license must be started after receiving the job offer. Preferred Qualifications • EPIC experience • Bachelor's Degree in Nursing Benefits • Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date • Disability insurance paid for by BJC • Annual 4% BJC Automatic Retirement Contribution • 401(k) plan with BJC match • Tuition Assistance available on first day • BJC Institute for Learning and Development • Health Care and Dependent Care Flexible Spending Accounts • Paid Time Off benefit combines vacation, sick days, holidays, and personal time • Adoption assistance