Swing Shift RN Clinical Review Management

St. Luke's Health System; Meridian (ID); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Fully Benefitted

Sign On Bonus Eligible

On-site massages

On-site counseling via EAP

Personify Health Wellness tool

Career development / formal training

Job summary

St. Luke’s Health System seeks a Clinical Review Nurse to join our Meridian team. You will review medical necessity for admissions, length of stay, and potential denial issues, applying criteria with clinical expertise to determine services required.

We offer intensive paid training, full benefits, a sign-on bonus eligible, and a supportive environment with on-site wellness resources. Requires Idaho RN license and 3 years' utilization management experience (BSN) or 5 years (ASN).

Qualifications

• Bachelor of Nursing or Associate of Nursing Degree.
• Experience in RN or utilization management: 3 years (BSN) or 5 years (ASN).
• Current RN license in Idaho.

Responsibilities

• Reviews the medical necessity of admission, continued hospitalization, length of stay, and potential denial of payment issues.
• Applies established criteria and clinical expertise to determine medical necessity of services.
• Communicates results to primary care team, specialty providers, vendors and members in compliance with regulatory and contractual requirements.

Skills

Utilization review

RN clinical judgment

Communication

Education

BSN

ASN

Job description

At St. Luke’s, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional patient experiences.

What You Can Expect:

• 8-hour shifts, 3-11 PM
• Intensive paid training
• Meridian location
• Reviews the medical necessity of admission, continued hospitalization, length of stay, and any potential denial of payment issues. Applies established criteria and employs clinical expertise to interpret clinical criteria to determine medical necessity of services. Performs Medicaid and Medicare review.
• Provides feedback and assistance to other members of the healthcare team regarding the appropriate use of resources and timely follow-through with the plan of care. Communicates results of reviews to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements.
• Fully Benefitted
• Sign On Bonus Eligible

Qualifications:

• Education: Bachelor of Nursing or Associates of Nursing Degree
• Experience: 3 years of RN or utilization management experience (BSN) or 5 years of RN or utilization management experience (ASN)
• Licenses/Certifications: Current RN license in Idaho

For more information, contact Julie at [e-mail]

What’s in it for you:

Requirements:
At St. Luke’s, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional patient experiences.

We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

• on-site massages
• on-site counseling via our Employee Assistance Program
• access to the Personify Health Wellness tool
• other formal training and career development offerings to ensure you are meeting your career goals

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.