What are the responsibilities and job description for the Utilization Review Clinician (RN) position at Saint Francis Healthcare?
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JOB SUMMARY
The Utilization Review Clinician, under the direct supervision of the Director of Case Management, accepts responsibility for identifying, reporting, and performing all utilization review processes and functions for all payers.The UR Clinician complies with utilization review standards/requirements for regulatory agencies and payers, including, but not limited to:
- Managed care contracts,
- Medicare/Medicaid regulations
- CHAMPUS
- Illinois Public Aid (IPA)
- TJC standards
The Utilization Review Clinician will demonstrate extreme tact and diplomacy, will possess good communication skills, both written and verbal, demonstrate the working knowledge of and the ability to plan, organize, implement, and evaluate operational activities within the utilization review system, possess the ability to serve as an effective team member, demonstrate the ability to properly inform professionals and medical staff related to utilization management to meet the needs of the organization.
JOB DETAILS AND REQUIREMENTS
Type: Full Time (72 hours per 2 week pay period, with benefits)
Typical Hours: Day Shift, 8 Hours/shift, weekend rotation
Education:
- Bachelors Nursing - Preferred
Certification & Licensures:
- Certification in Utilization Management - preferred
- Currently licensed to practice as a Registered Nurse in the State of Missouri.
Experience:
- Nursing experience of at least one year is highly preferred
ADDITIONAL INFORMATION
Saint Francis Healthcare System provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, or genetics. In addition to federal law requirements, Saint Francis Healthcare System complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
In compliance with the ADA Amendments Act (ADAAA) should you have a disability and would like to request an accommodation in order to apply for a currently open position with Saint Francis Healthcare System, please call 573-331-5152 or email us at hr@sfmc.net.
Saint Francis Healthcare System supports the overall health and wellness of our colleagues by discouraging the use of tobacco and nicotine products. If you are selected for a career opportunity with our organization, and are a tobacco or nicotine user, you will be required to complete a tobacco/nicotine cessation program within your first year of employment. This program is free of charge as part of our Employee Assistance Program.
