Utilization Review Nurse - RN

Job Description
Additional Information About the Role Attention Hospital or Insurance Registered Nurses with Utilization Review Experience! 🏥💼 Looking for a stable work-from-home opportunity? We have a fantastic opening for a remote local RN position. Join our team and enjoy a fulfilling remote role. 2 years of utilization review (UR) experience in a hospital or insurance company and EPIC experience are highly preferred. Details of the position: 🕒 Schedule: 48 hours per pay period, Wed-Friday 8 a.m. - 4:30 p.m., with one Sunday weekend shift per month 🏠 Location: Must reside within one hour of the BJC Learning Institute in St. Louis 🚫 No patient communications involved Overview BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development. BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. Preferred Qualifications Role Purpose Ensure that the administration of hospital resources are appropriate, efficient and fall 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, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation. Education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources. Responsibilities Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care. Uses Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting. Minimum Requirements Education Nursing Diploma/Associate's - Nursing Experience 2-5 years Supervisor Experience No Experience Licenses & Certifications RN Preferred Requirements Education Bachelor's Degree - Nursing Benefits and Legal Statement BJC Total Rewards At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being. Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date Disability insurance* paid for by BJC Pension Plan*/403(b) Plan funded by BJC 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 To learn more, go to www.bjctotalrewards.com/Benefits *Not all benefits apply to all jobs The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity EmployerQualifications
Role Purpose Ensure that the administration of hospital resources are appropriate, efficient and fall 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, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation. Education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources. Responsibilities Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care. Uses Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting. Minimum Requirements Education Nursing Diploma/Associate's - Nursing Experience 2-5 years Supervisor Experience No Experience Licenses & Certifications RN Preferred Requirements Education Bachelor's Degree - Nursing
Responsibilities
BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development. BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.