Utilization Review Registered Nurse

BJC HealthCare; St. Louis (MO); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled nurse to join their remote team, focusing on utilization review and patient care management. This role involves evaluating hospital admissions for medical necessity, ensuring efficient use of resources while maintaining high-quality care. With a commitment to community health and well-being, the organization offers a supportive environment where your expertise can make a significant impact. If you have a passion for healthcare and a desire to contribute to a leading nonprofit organization, this opportunity is perfect for you.

Benefits

Comprehensive medical, dental, and vision insurance

Disability insurance paid for by BJC

Pension Plan/403(b) Plan funded by BJC

401(k) plan with BJC match

Tuition Assistance

Health Care and Dependent Care Flexible Spending Accounts

Paid Time Off benefit

Adoption assistance

Qualifications

• 2 years of staff nurse experience for hospitalized patients.
• 2 years of utilization review experience for hospital admissions.

Responsibilities

• Review and interpret diagnostic test results for patient care.
• Evaluate cost and quality of medical services provided.

Skills

Clinical Skills

Analytical Skills

Utilization Review

Interqual Criteria

Education

Nursing Diploma/Associate's

Bachelor's Degree

Tools

EPIC

Job description

Additional Information About the Role

Join a stable work from home team. This is a great opportunity for a local remote position.

Schedule

80 hours/per pay period (two weeks) -

• Monday-Friday 8 a.m. - 4:30 p.m.

Weekend Requirement - 1 Sunday every 4 weeks.

No patient communication.

Requirements:

• 2 years of staff nurse 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 Learning Institute in St. Louis.
• Have both Missouri and Illinois RN licenses.

• If candidate only has one RN license, (MO or IL) the application process for the 2nd license can be started after receiving the job offer.

• EPIC experience is a plus!

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

Experience

• 2-5 years

Supervisor Experience

• No Experience

Licenses & Certifications

• RN

Preferred Requirements

Education

• Bachelor's Degree

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, vision, 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 Employer