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:

Job Details

The best place to get care. The best place to give care. Saint Lukes 12000 employees strive toward that vision every day. Our employees are proud to work for the only faithbased nonprofit locally owned health system in Kansas City. Joining Saint Lukes 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 regions premiere provider of health services. Equal Opportunity Employer.