RN-Utilization Review

About This Role

Evaluate the medical necessity and appropriateness of hospital admissions and surgical procedures for a healthcare organization. Serve as a liaison between payors and the hospital to ensure authorization and support for services provided.

Responsibilities

• Discuss criteria and payor decisions with payors
• Escalate denials to physicians for peer-to-peer consideration
• Document outcomes in the electronic medical record
• Participate with team members to identify opportunities for standard work improvement
• Perform reviews of pre-admission, perioperative, and postoperative surgical cases
• Apply evidence-based practice and scientific knowledge to nursing practice

Requirements

• Graduate of accredited school of nursing or education equivalency for licensing
• Two years’ registered nurse experience
• Registered Nurse (RN) license in Illinois, Missouri, Oklahoma, or Wisconsin, or a Compact State license

Qualifications

• Graduate of accredited school of nursing or education equivalency for licensing
• Two years’ registered nurse experience

Nice to Have

• Strong computer skills
• EPIC experience
• Prior Utilization Review (UR) experience
• Compact license or licensure in more than one state

Skills

* Required skills

Benefits