RN-Utilization Review; S
Listed on 2026-02-01
-
Nursing
RN Nurse, Healthcare Nursing
It's more than a career, it's a calling
MO-REMOTE
Worker Type: Regular
Job Highlights:
The selected candidate must reside in our four state footprint. Missouri, Illinois, Oklahoma or Wisconsin only.
Job Summary:Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.
Primary Responsibilities- Discusses with payor regarding criteria and payor decision.
- Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration.
- Documents outcome in electronic medical record.
- Participates with other members of team regarding opportunities for improvement in standard work.
- Performs review of pre-admission, perioperative, and post operative surgical cases.
- Performs other utilization management tasks as assigned.
- Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.
- Performs other duties as assigned.
- Graduate of accredited school of nursing or education equivalency for licensing
- Two years’ registered nurse experience
State of
Work Location:
Illinois
- Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
State of
Work Location:
Missouri
- Registered Nurse (RN) Issued by Compact State
- Or
- Registered Nurse (RN) - Missouri Division of Professional Registration
State of
Work Location:
Oklahoma
- Registered Nurse (RN) Issued by Compact State
- Or
- Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
State of
Work Location:
Wisconsin
- Registered Nurse (RN) Issued by Compact State
- Or
- Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
Work Shift: Day Shift (United States of America)
Job Type: Employee
Department: Sys Utilization Management
Scheduled Weekly
Hours:
40
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
- Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
- Flexible Payment Options: our voluntary benefit offered through Daily Pay offers eligible hourly team members instant access to their earned, unpaid base pay(fees may apply) before payday.
- Upfront Tuition Coverage: we provide upfront tuition coverage through Flex Path Funded for eligible team members.
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.
#J-18808-Ljbffr(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).