About this role
Job Description
The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position includes monitoring patient charts and utilization of health care services. Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.
Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual).
Complies with CMS regulation regarding utilization review/management.
Obtains and manages insurance authorizations and proactively works denials to help mitigate financial impact.
Submits referrals for secondary level review as appropriate and follows through on process.
Documents communication and work in electronic medical record.
Works with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing.
Job Requirements
Applicable Experience:
Less than 1 yearRegistered Nurse - VariousAssociate DegreeJob Details
Full TimeDay (United States of America)The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.
Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.
Other facts
About Saint Luke's Health System
About Saint Luke’s Health System
Saint Luke’s serves the West Region of BJC Health System as a faith-based, nonprofit, aligned health system committed to providing the highest levels of excellence in compassionate health care and health-related services. Saint Luke’s cares for patients in 65 specialty services across 67 counties in Missouri and Kansas. Saint Luke’s Hospital has been recognized by U.S. News & World Report as one of the elite hospitals in the nation. For more than 140 years, Saint Luke’s has been dedicated to enhancing the physical, mental, and spiritual health of the diverse communities we serve.
Saint Luke’s offers:
- The region’s longest continuously operating adult heart transplant program and one of the nation’s leading cardiovascular programs at Saint Luke's Mid America Heart Institute
- Treatment for complex brain and spinal cord diseases and one of the nation’s leading stroke reversal programs at the nationally ranked Saint Luke’s Marion Bloch Neuroscience Institute
- The region’s only treatment center dedicated exclusively to treating metastatic breast cancer—the Koontz Center for Advanced Breast Cancer at Saint Luke’s Cancer Institute
- Saint Luke’s Convenient and Urgent Care clinics for treatment of minor illnesses and injuries
- Liver and kidney transplantation programs
- A comprehensive maternal-fetal diagnostic and treatment center
- Three Neonatal Intensive Care Units, including a Level IIIb NICU at Saint Luke’s Hospital of Kansas City
- Saint Luke’s Rehabilitation Institute, the only comprehensive inpatient rehabilitation hospital of its kind in the region
- A nationally recognized children's behavioral health center, Saint Luke’s Hospital Crittenton Children’s Center
What you'll do
- The Utilization Review RN is responsible for ensuring high quality, cost-efficient medical outcomes through utilization review and management. This includes monitoring patient charts, collaborating with healthcare professionals, and managing insurance authorizations.
Ready to join Saint Luke's Health System?
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