Utilization Review WEO RN

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

Facility:Remote Missouri: 1423 North Jefferson Avenue, Springfield, Missouri, United States of America, 65802Department:1665 Utilization ReviewScheduled Weekly Hours:40Hours:7:00 AM-5:30 PMWork Shift:Day Shift (United States of America)CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas. The organization includes six hospitals, 5 ERs, and over 80 clinics. CoxHealth has earned the following honors for workplace excellence:Named one of Modern Healthcare’s Best Places to work five times.Named one of America’s Greatest Workplaces, Greatest Workplaces in Healthcare (2025, 2026), Greatest Workplaces for Women (2023, 2024), and Greatest Workplaces for Diversity (2024) by Newsweek and Plant-A Insights Group.Acknowledged by Forbes as one of the Best Employers for New Grads.Healthcare Innovation's Top Companies to Work for in Healthcare (2025).BenefitsMedical, Vision, Dental, Retirement with Employer Match and more (20+ hrs/week)For a comprehensive list of benefits, please click here: Benefits | CoxHealthJob Description:The Utilization Review Nurse RN collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient's progress, intervening appropriately to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective. Conduct concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, accrediting bodies, and other state agencies. Prospectively or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines and insurance benefits and communicates information to payers in accordance with contractual obligations. Serve as a resource to the physicians and provide education and information on resource utilization, national and local coverage determinations, and use of hospital admission criteria.Education: Required: Graduate of an accredited school of nursing Preferred: Bachelor's of Nursing with knowledge of InterQual Level of Care Criteria and/or Milliman Care Guidelines and of local/national coverage determinations Experience: Required: Minimum of 3 years hospital experience Skills: Excellent interpersonal skills, including ability to be genuine and empathetic Excellent communication (verbal and written) skills with attention to detail Computer skills Ability to interact professionally and contribute to the interdisciplinary team Licensure/Certification/Registration: Current RN License active in the state of Missouri Preferred: Certified Case Manager