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CoxHealth Utilization Review Registered Nurse - Utilization Review

Company: CoxHealth
Location: Springfield
Posted on: August 6, 2022

Job Description:

Summary Job Summary The Utilization Review Nurse RN collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient's progress, intervening appropriately to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective. Conduct concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, accrediting bodies, and other state agencies. Prospectively or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines and insurance benefits and communicates information to payers in accordance with contractual obligations. Serve as a resource to the physicians and provide education and information on resource utilization, national and local coverage determinations, and use of hospital admission criteria. Job Requirements Education Required: Graduate of an accredited school of nursing Preferred: Bachelor's of Nursing with knowledge of InterQual Level of Care Criteria and/or Milliman Care Guidelines and of local/national coverage determinations Experience Required: Minimum of 3 years hospital experience Skills Excellent interpersonal skills, including ability to be genuine and empathetic Excellent communication (verbal and written) skills with attention to detail Computer skills Ability to interact professionally and contribute to the interdisciplinary team Licensure/Certification/Registration Current RN License in the state of Missouri Preferred: Certified Case Manager Additional Information Job Benefits & Perks! Preventive Health Plans available On-site Daycare with extended hours, holidays and weekends Employee Discount at CoxHealth Fitness Centers Pharmacy delivery to your unit On-site Employee Health services Opportunity to earn referral bonuses of up to $5,000 per hire for certain positions 1906 Employee Store Cafeteria discount If you would like more information about job benefits & perks, please feel free to email us @ hr-recruitment@coxhealth.com or visit https://www.coxhealth.com/employees/benefits/

Keywords: CoxHealth, Springfield , CoxHealth Utilization Review Registered Nurse - Utilization Review, Healthcare , Springfield, Missouri

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