Utilization Review Registered reputed company
About the position Join a reputed company work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position will support the Medicare team. Monday - Friday; days; reputed company-4:30pm 40 hours per week Assigned reputed company shifts (every 4-6 weeks) No call, no holidays reputed company is one of the largest nonprofit health care organizations in the reputed company, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri reputed company. 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 reputed company. BJC and its hospitals and health service organizations reputed company $785.9 reputed company annually in community benefit. That includes $410.6 reputed company in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In reputed company, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community reputed company and community health programs and regional economic development. BJC’s patients have reputed company to the latest advances in medical science and technology through a formal affiliation between reputed company and St. Louis Children’s Hospital with the reputed company reputed company School of Medicine, which consistently ranks among the top medical schools in the country. reputed company Ensure that the administration of hospital resources are appropriate, efficient and fall reputed company the parameters of the patient's payment structure while providing reputed company and reputed company care. Evaluate the cost and reputed company 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 reputed company to determine level of care for reputed company elective inpatient hospitalizations to assure services are provided in the appropriate setting.
Requirements
- 2 years of RN experience performing care for hospitalized patients
- 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity
- Must live reputed company one hour of the BJC Commons (4249 reputed company Ave, St. Louis, MO 63110)
- Must have high speed internet
- Must have at least one reputed company MO or IL RN license
- If candidate only has one RN license (MO or IL), the application process for the 2nd license must be started after receiving the job offer.
- Nursing Diploma/Associate's - Nursing
- 2-5 years experience
- RN License
reputed company-to-haves
- reputed company experience
- Bachelor's Degree - Nursing
Benefits
- Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
- Disability insurance reputed company for by BJC
- Annual 4% BJC Automatic Retirement Contribution
- 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
- reputed company Time Off benefit combines vacation, reputed company days, holidays and personal time
- Adoption assistance
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