Care Coordination Specialist

4 weeks ago


St Louis, Missouri, United States BJC HealthCare Full time

Overview

BJC HealthCare is a leading nonprofit healthcare organization delivering services to residents in the greater St. Louis, southern Illinois, and southeast Missouri regions.

We are seeking a highly skilled Care Coordination Specialist - Utilization Review to join our team. In this role, you will ensure that hospital resources are utilized appropriately, efficiently, and within the parameters of patients' payment structures while providing safe and quality care.

About the Role

The Care Coordination Specialist - Utilization Review will be responsible for evaluating the cost and quality of medical services provided by the medical team, ensuring appropriate utilization, and educating medical providers and other healthcare professionals on the appropriate and cost-effective use of healthcare resources.

Key Responsibilities

  • Evaluating diagnostic test results to determine the appropriateness of patient care levels
  • Determining the level of care for elective inpatient hospitalizations using Interqual Criteria
  • Ensuring services are provided in the appropriate setting

Requirements

To be successful in this role, you will need:

  • A Nursing Diploma/Associate's degree
  • 2-5 years of experience in staff nursing, with 2 years of utilization review experience reviewing hospital admissions for medical necessity
  • RN licensure in Missouri and Illinois (or ability to obtain)
  • EPIC experience preferred

Compensation

We offer a competitive salary range of $


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