Remote Utilization Review RN – Care Optimization

CoxHealth; Springfield (MO); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Retirement with employer match

Job summary

CoxHealth in Springfield, MO is seeking a Utilization Review Nurse RN to collaborate with physicians and a multidisciplinary team to drive patient-focused, evidence-based care. The role conducts concurrent medical record reviews for medical necessity and level of care, and assesses inpatient vs observation needs in line with guidelines and payer requirements.

You will educate colleagues on resource utilization, coverage determinations, and admission criteria, contributing to cost-effective,

Qualifications

• Minimum of 3 years hospital experience.
• Knowledge of InterQual/MMG guidelines preferred.
• Strong written and verbal communication skills.
• Ability to work with multidisciplinary teams in a fast-paced setting.

Responsibilities

• Collaborate with physicians and multidisciplinary teams to facilitate progression of care.
• Perform concurrent medical record review for medical necessity and level of care.
• Determine inpatient vs observation appropriateness based on guidelines and payer requirements.
• Educate and inform on resource utilization and coverage determinations.

Skills

Interpersonal skills

Communication skills

Attention to detail

Computer skills

Team collaboration

Education

Graduate of an accredited school of nursing

Bachelor's in Nursing

Job description

CoxHealth in Springfield, MO is seeking a Utilization Review Nurse RN to collaborate with physicians and a multidisciplinary team to drive patient-focused, evidence-based care. The role conducts concurrent medical record reviews for medical necessity and level of care, and assesses inpatient vs observation needs in line with guidelines and payer requirements.

You will educate colleagues on resource utilization, coverage determinations, and admission criteria, contributing to cost-effective,