Utilization Review RN (Care Coordination; Full-time; Days)

Company: St. Alexius Hospital Corp
Location: Saint Louis
Posted on: September 15, 2020

Job Description:

Description:
The utilization review nurse works with a high degree of independence to ensure that utilization management requirements established by payors are carried out in timely manner. The utilization review nurse works collaboratively with payors, staff, and case manager to track ongoing care needs and utilization requirements and/or guidelines..

Requirements:
JOB REQUISITES:EDUCATION AND TRAINING:Graduate of a School of Nursing requiredBSN preferredLICENSING/REGISTRATION/CERTIFICATION: Licensed as an RN in the State of Missouri.EXPERIENCE:Previous medical or psychiatric experience preferred; prior UR experience preferredSKILLS AND ABILITIES:Knowledge of applicable clinical populations.Knowledge of health care continuum.Knowledge of and skill in accessing community resources.Familiarity with medical terminology and discharge planning.General knowledge of DRG, APC, CPT, and ICD-9CM coding.Basic understanding of statistical and quality irmprovement techniques and reports.Knowledge of treatment protocols, standards and guidelines.Knowledge of resources and case management.Working knowledge of health care finance and third party payment methods.Ability to work independently, as part of a team, and with others from diverse backgrounds.Developed negotiation skills.Effective communication skills.Experience with PC, mainframe or Internet based information system.Working knowledge of a personal computer and basic software packages.An individual without requisites stated above may present a written justification explaining the relevance of his/her background for a specific vacant position. Depending on organizational needs and availability of more qualified applicants, an applicant may have some or all requisites revised or waived at the hospital's discretion.PM20 PI123561946

Keywords: St. Alexius Hospital Corp, St. Louis , Utilization Review RN (Care Coordination; Full-time; Days), Healthcare , Saint Louis, Missouri