Remote Utilization Review RN — Care Quality & Payer Liaison

Skaggs Community Hospital Association; United States; On-site; USD 41,000 - 62,000; Full time

Benefits offered by this job

Medical, Vision, Dental, Retirement сh

Job summary

CoxHealth seeks a Utilization Review Nurse RN to collaborate with physicians and the care team to facilitate progression of care in a Missouri facility. You will monitor patient progress, ensuring the plan of care is high quality, evidence-based, and cost effective, with education for staff on resource use.

Responsibilities include conducting concurrent reviews for medical necessity and communicating with payers per contractual obligations, while serving as a resource to clinicians on admission

Qualifications

• Graduate of an accredited school of nursing.
• Preferred: Bachelor's of Nursing with knowledge of InterQual/Milliman guidelines.
• Current Missouri RN license active.
• Minimum 3 years hospital experience.

Responsibilities

• Collaborate with physicians and multidisciplinary team to facilitate progression of care.
• Monitor patient progress and ensure plan of care is patient-focused and cost effective.
• Conduct concurrent medical record review for medical necessity and level of care.
• Communicate with payers regarding benefits and coverage criteria.

Skills

Interpersonal skills

Communication skills

Computer skills

Team collaboration

Education

Graduate of accredited nursing program

BSN preferred

Missouri RN license

Job description

CoxHealth seeks a Utilization Review Nurse RN to collaborate with physicians and the care team to facilitate progression of care in a Missouri facility. You will monitor patient progress, ensuring the plan of care is high quality, evidence-based, and cost effective, with education for staff on resource use.

Responsibilities include conducting concurrent reviews for medical necessity and communicating with payers per contractual obligations, while serving as a resource to clinicians on admission