Utilization Review WEO RN

CoxHealth; United States; Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, Vision, Dental, Retirement w/

Employer Match

Job summary

CoxHealth, a leading health system serving multiple counties in Missouri, seeks a Utilization Review Nurse RN. You will collaborate with physicians and care teams to ensure high-quality, cost-effective care while reviewing medical necessity and level of care for inpatient or observation services.

Strong nursing background and knowledge of utilization criteria are essential. The role requires at least 3 years of hospital experience, and the nurse will support education on resource use and

Qualifications

• Graduate of an accredited school of nursing.
• Minimum of 3 years hospital experience.

Responsibilities

• Collaborates with physicians and multidisciplinary team to facilitate progression-of-care.
• Monitors patient progress and ensures plan of care is high quality, evidence-based, and cost-effective.
• Reviews inpatient vs observation criteria and communicates with payers per contractual obligations.
• Provides education and information on resource utilization and coverage determinations.

Skills

Interpersonal skills

Communication

Computer skills

Team collaboration

Education

RN license (MO)

Bachelor’s in Nursing (preferred)

Job description

Facility:

Remote Missouri: 1423 North Jefferson Avenue, Springfield, Missouri, United States of America, 65802

Department:

1665 Utilization Review

Scheduled Weekly Hours:

40

Hours:

7:00 AM-5:30 PM

Work 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’sTop Companies to Work for in Healthcare (2025).

Benefits

• Medical, Vision, Dental, Retirement with Employer Match and more (20+ hrs/week)
• For a comprehensive list of benefits, please click here: Benefits | CoxHealth

Job 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