Utilization Review RN - Remote

CoxHealth • Full-time • Springfield, Missouri, United States • 3w ago

Summary

About Us

CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas. The organization includes six hospitals, 5 ERs, and over 80 clinics.CoxHealth has earned the following honors for workplace excellence:

Named one of Modern Healthcare’s Best Places to work five times
Named one of America’s Greatest Workplaces by Newsweek in 2024.
Recognized as a Greatest Workplace for Women in both 2023 and 2024.
Listed as one of the Greatest Workplaces for Diversity in 2024.
Acknowledged by Forbes as one of the Best Employers for New Grads in 2023.
Ranked among the Best Employers by State for Missouri.
Healthcare Innovation's Top Companies to Work for in Healthcare in 2025.

Benefits

Medical, Vision, Dental, Retirement Plan with employer match, and many more!
For a comprehensive list of benefits, please click here: Benefits | CoxHealth

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 active in the state of Missouri
  - Preferred: Certified Case Manager

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