Utilization Review Registered Nurse

BJC HealthCare (New); Northern (KY); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Tuition Assistance

Paid Time Off

Job summary

BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation.

Responsibilities include applying Interqual criteria, reviewing admissions for medical necessity, and educating providers on resource use. Two to five years of inpatient nursing experience and UR experience are required; EPIC experience preferred.

Qualifications

• 2-5 years of nursing experience in a hospital setting.
• 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 only one license, second license process must start after offer.
• EPIC experience preferred.

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.

Education

Nursing Diploma/Associate's - Nursing

Bachelor's Degree - Nursing

Tools

EPIC experience

Job description

Additional Information About the Role

Join a stable work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position supports all units/staff (commercial, behavioral health, inpatient, etc.)

• PRN (at minimum, two 8hr shifts every pay period)
• Monday - Friday; days; 8am-4:30pm
• Assigned Sunday shifts (every 4-6 weeks)
• No major holidays

Orientation schedule: PRN hires must be available for full-time orientation for 2 full weeks, Monday - Friday from 8am-4:30pm.

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.

Additional Preferred Requirements

• EPIC experience

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 $6.3billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14hospitals 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
• 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

To learn more, go to our Benefits Summary.

*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 Employer