Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
- This role involves evaluating the medical necessity and appropriateness of hospital admissions and surgical procedures.
- Discusses with payor regarding criteria and payor decision.
- Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration.
- Documents outcome in electronic medical record.
- Participates with other members of team regarding opportunities for improvement in standard work.
- Performs review of pre-admission, perioperative, and post operative surgical cases.
- Performs other utilization management tasks as assigned.
- Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice.
- Ensures 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.
- Qualifications
- Graduate of accredited school of nursing or education equivalency for licensing
- Two years’ registered nurse experience
- Requirements
- Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
- Registered Nurse (RN) Issued by Compact State (Missouri)
- Registered Nurse (RN) - Missouri Division of Professional Registration
- Registered Nurse (RN) Issued by Compact State (Oklahoma)
- Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
- Registered Nurse (RN) Issued by Compact State (Wisconsin)
- Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
- Benefits
- Paid Parental Leave: one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
- Flexible Payment Options: instant access to earned, unpaid base pay through DailyPay (fees may apply).
- Upfront Tuition Coverage: upfront tuition coverage through FlexPath Funded for eligible team members.
Apply tot his job
Apply To this Job