RN Utilization Review Specialist

1 week ago


New York, New York, United States SSM Health Full time
Job Summary

As a Utilization Review Nurse with SSM Health, you will play a critical role in ensuring that payors receive accurate clinical information to support services provided by our hospital. Your expertise will help ensure that our hospital receives authorization from payors, ensuring seamless care for our patients.

Key Responsibilities
  • Review electronic medical records and screen clinical information using nationally recognized criteria.
  • Discuss with payors regarding criteria and payor decisions.
  • Escalate denials to physicians for peer-to-peer consideration.
  • Document outcomes in electronic medical records.
  • Collaborate with team members to identify opportunities for improvement in standard work.
Requirements
  • Graduate of an accredited school of nursing or equivalent education for licensure.
  • Two years of registered nurse experience.
  • State-specific licensure requirements (IL, MO, OK, WI).
About SSM Health

SSM Health is an equal opportunity employer. We do 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.



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