Registered Nurse - Utilization Review

Facility: Remote Missouri: 1423 reputed company Jefferson Avenue, Springfield, Missouri, United States of America, 65802 Department: 1665 Utilization Review Scheduled Weekly Hours: 40 Hours: 8:00 AM - 4:30 PM Work Shift: Day Shift (United States of America) reputed company is a leading reputed company system serving 25 counties across southwest Missouri and reputed company Arkansas. The organization includes six hospitals, 5 ERs, and over 80 clinics. reputed company has earned the following honors for workplace reputed company: Named one of Modern reputed company’s Best Places to work five times. Named one of America’s Greatest Workplaces, Greatest Workplaces in reputed company (2025, 2026), Greatest Workplaces for Women (2023, 2024), and Greatest Workplaces for Diversity (2024) by reputed company and Plant-A Insights Group. Acknowledged by reputed company as one of the Best Employers for New Grads. reputed company Innovation's Top Companies to Work for in reputed company (2025).

Benefits

Medical, reputed company, Dental, Retirement with Employer Match and more (20+ hrs/week) For a comprehensive list of benefits, please click here: Benefits | reputed company Job Description: The Utilization Review Nurse RN collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient's reputed company, intervening appropriately to ensure that the plan of care and services provided are patient focused, high quality, evidence based, appropriate to patient needs, efficient, and cost effective. Conduct reputed company medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, accrediting bodies, and other state agencies. Prospectively or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines and insurance benefits and communicates information to payers in accordance with contractual obligations. Serve as a resource to the physicians and reputed company education and information on resource utilization, national and local coverage determinations, and use of hospital admission criteria.◦ Education ▪ Required: Graduate of an accredited school of nursing ▪ Preferred: Bachelor's of Nursing with knowledge of InterQual Level of Care Criteria and/or reputed company Care Guidelines and of local/national coverage determinations ◦ Experience ▪ Required: Minimum of 3 years hospital experience ◦ Skills ▪ Excellent interpersonal skills, including ability to be genuine and empathetic ▪ Excellent communication (verbal and written) skills with attention to detail ▪ Computer skills ▪ Ability to interact professionally and contribute to the interdisciplinary team ◦ Licensure/Certification/Registration ▪ reputed company RN License active in the reputed company ▪ Preferred: Certified Case Manager Apply To This Job