Registered Nurse – Utilization Review

🔥 3 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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CoxHealth

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1906

🏥 Healthcare

🧘 Wellness

📚 Education

Healthcare • Wellness • Education

CoxHealth is a regional, not-for-profit integrated health care system serving southwest Missouri, operating hospitals, urgent care centers, clinics, specialty services (including cardiology, cancer care, orthopedics, neurology, and pediatrics), home health, and ancillary services. With hundreds of physicians, extensive outpatient locations, training and residency programs, and community-focused patient resources, CoxHealth provides comprehensive clinical care, patient support services, and health education to individuals and families across the Ozarks.

📋 Description

• Collaborate with physicians and the multidisciplinary team to facilitate progression of care • Monitor patient progress and intervene appropriately to ensure patient-focused, high-quality, evidence-based, appropriate, efficient, and cost-effective care • Conduct concurrent medical record reviews for medical necessity and level of care using nationally recognized acute care indicators and criteria • Prospectively or concurrently determine the appropriateness of inpatient or observation services based on medical documentation, medical guidelines, and insurance benefits • Communicate information to payers in accordance with contractual obligations • Serve as a resource to physicians • Educate and provide information on resource utilization, national and local coverage determinations, and hospital admission criteria

🎯 Requirements

• Graduate of an accredited school of nursing • Minimum of 3 years of hospital experience • Excellent interpersonal skills, including the ability to be genuine and empathetic • Excellent verbal and written communication skills with attention to detail • Computer skills • Ability to interact professionally and contribute to the interdisciplinary team • Current RN license active in the state of Missouri • Knowledge of InterQual Level of Care Criteria and/or Milliman Care Guidelines preferred • Knowledge of local and national coverage determinations preferred • Bachelor's of Nursing preferred • Certified Case Manager preferred

🏖️ Benefits

• Medical insurance • Vision insurance • Dental insurance • Retirement plan with employer match • Benefits available for employees working 20+ hours per week • Workplace recognized by Modern Healthcare, Newsweek, Forbes, and Healthcare Innovation