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WI-REMOTE

Worker Type:

Regular

Job Highlights:

• Department: Utilization Review​

• Schedule: Full Time, Day Shift, 8:30am-5:00pm; every 3rd weekend rotation

• Starting Pay: $67,766.40+ (Offers are based on years of experience and equity for this role. ) ​

• Location: Remote ( candidate must live in IL, MO, OK, or WI )*

*If living in MO, OK, or WI, candidate must have multistate licensure; if living in IL, candidate must have individual state licensures for all four states (IL, MO, WI, and OK).

Candidate must have prior hospital utilization review experience and 2 years inpatient RN experience (ER and ICU experience is a plus!)

Job Summary:

Ensure payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Reviews electronic medical record and screens clinical information with nationally recognized criteria.

• 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.

• Active participant with other members of team regarding opportunities for improvement in standard work.

• As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model.

• Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.

• Performs other duties as assigned.

EDUCATION

• Graduate of accredited school of nursing or education equivalency for licensing

EXPERIENCE

• Two years' registered nurse experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.

• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.

• Frequent keyboard use/data entry.

• Occasional bending, stooping, kneeling, squatting, twisting and gripping.

• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

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:

8746030033 Sys Utilization Management

Scheduled Weekly Hours:

40

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. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?_ga=2.205881493.704955970.1667719643-240470506.1667719643)