Mercy Health Job - 31544626 | CareerArc
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Company: Mercy Health
Location: Chesterfield, MO
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

We're a Little Different

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, you'll feel our supportive community every step of your day, especially the tough ones. We're a team and love working that way. We have opportunities for nurses who are inspired to pioneer new models of care and want to transform the healthcare experience. Work with advanced technology and innovative procedures. Be state of the art, and never stop exploring. We're expanding to help our communities grow, offering an exceptional opportunity to join our team.

*This is position has the opportunity to work remotely after training in Chesterfield, MO*

The Utilization Review Nurse is responsible for the development, implementation, coordination, and follow-up of projects related to Mercy Care Management. This includes the validation, assimilation, and integration of information derived from projects, focus studies, in network and out of network pre-certification, inpatient concurrent review and retrospective chart review. Performs related duties as assigned. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.

Coordinates and performs precertification, out of network precertification, inpatient concurrent review, retrospective review, reconsiderations and appeals. Performs each review process following the appropriate policy & procedure and within standard time frames.

Collaborates with physicians and staff to provide medical management education and follow-up for precertifications, inpatient concurrent review, retrospective review and appeals. Collaborates with providers, as indicated, to provide them with medical management information.

Performs telephone management with professional telephone etiquette when communicating with all parties.

Collects and researches medical records and other forms of information to make effective and accurate non-medical decisions concerning all medical management review processes.

Composes, types and mail standard letters of denials to health plan members, providers, and health plans member services referencing specific medical criteria utilized in the determination.

Collaborates with physicians, facilities, health plan member services and claims staff as needed to obtain information regarding claim denials, their status, and actions taken that may affect their outcome.

Position Qualifications:

  • BSN Preferred
  • You'll also need a current RN license in our state.
  • Minimum of three years clinical experience.
  • Basic life support training should be completed in 90 days with advanced training required at certain intervals.

We'll Support You at Work and Home

Getting respect doesn't come easy in healthcare. Modern Healthcare Magazine named us as a “top 100 places to work.” We go out of our way to help people feel welcomed. We offer day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds to benefit-eligible co-workers, including those working 48 hours or more per pay period!

What Makes a Good Match for Mercy

Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We're also collaborative and are not afraid to do a little extra to deliver excellent care-that's just part of our commitment. If that sounds like a fit for you as well, we encourage you to apply.

Utilization Review Nurse, RN, Nurse

#CBE


Mercy has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.


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