It's more than a career, it's a calling
MO-REMOTEWorker Type:
Job Highlights:
Job Summary:
Provide concurrent utilization review for appropriate statusing and ensure CMS compliance.Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
- Reviews electronic medical record and screens clinical information with nationally recognized criteria.
- Communicates with physicians regarding patient admission status.
- Reviews Medicare beneficiary short stay hospital admissions.
- Collaborates with attending physician and case managers regarding Condition Code 44 accounts.
- Reviews inpatient admissions changed to outpatient for possible Condition Code 44 criteria.
- Identifies and escalates barriers/gaps to leader of department.
- Participates with other members of team regarding opportunities for improvement in standard work.
- Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service.
- Performs other duties as assigned.
EDUCATION
- Graduate of accredited school of nursing or education equivalency for licensing
EXPERIENCE
- Two years' acute care experience
PHYSICAL REQUIREMENTS
- Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
- Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
- Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
- Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
- Frequent keyboard use/data entry.
- Occasional bending, stooping, kneeling, squatting, twisting and gripping.
- Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
- Rare climbing.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
- Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
State of Work Location: Missouri
- Registered Nurse (RN) Issued by Compact State
- Or
- Registered Nurse (RN) - Missouri Division of Professional Registration
State of Work Location: Oklahoma
- Registered Nurse (RN) Issued by Compact State
- Or
- Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
State of Work Location: Wisconsin
- Registered Nurse (RN) Issued by Compact State
- Or
- Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
Work Shift:
Day Shift (United States of America)Job Type:
Department:
Benefits:
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
Skills Required
- Graduate of accredited school of nursing or equivalent
- Two years acute care nursing experience
- Registered Nurse (RN) license in the employee's state of work (or compact RN where allowed) per state-specific requirements
- Reside in one of the approved states (AL, FL, GA, IL, IN, IA, KS, KY, LA, MI, MO, NC, OK, SC, TN, TX, UT, WV, WI)
- Prior Utilization Management (UM) experience
- Knowledge of EPIC electronic medical record system
What We Do
SSM Health is a Catholic, not-for-profit, fully integrated health system dedicated to advancing innovative, sustainable, and compassionate care for patients and communities throughout the Midwest and beyond. The organization serves comprehensive health needs through hospitals, physician offices, outpatient and virtual care services, comprehensive home care and hospice services, a fully transparent pharmacy benefit company, a health insurance company and an accountable care organization.
