Utilization Review Manager

­ditional Information About the Role - Monday - Friday, 8am - 4:30pm - Salaried position with full benefits - Knowledge of payers- compliant and regulatory guidelines preferred! Overview Missouri Baptist Medical Center, an acute care hospital in St. Louis County, offers a full continuum of medical and surgical services, including heart care, cancer, women and infants, breast health, gastrointestinal, orthopedic, stroke, therapy, wound and pain management services. The hospital has a 24-hour adult emergency department and cares for pediatric patients at a separate emergency department in collaboration with St. Louis Children’s Hospital. Missouri Baptist is the first and only hospital in St. Louis County to be named a Magnet® hospital by the American Nurses Credentialing Center (ANCC). The prestigious designation is the highest credential a health care organization can receive for nursing excellence and quality patient care. This recognition has been accomplished by less than nine percent of hospitals nationwide. Additionally, U.S. News & World Report ranked the hospital
2 in the St. Louis metro area. Preferred Qualifications Role Purpose Ensure that the administration of hospital resources are appropriate, efficient and fall within the parameters of the patient's payment structure while providing safe and quality care. Evaluate the cost and quality of medical services provided by the medical team. Ensure appropriate utilization, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation. Education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources. Responsibilities Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care. Uses Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting. BJC 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. Performs Other Responsibilities as Assigned Minimum Requirements Nursing Diploma/Associate's Degree in Nursing RN License 2-5 years of experience Preferred Requirements Bachelor's Degree in Nursing Benefits and Legal Statement BJC Total Rewards At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being. Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date Disability insurance* paid for by BJC Pension Plan*/403(b) Plan funded by BJC 401(k) plan with BJC match Tuition Assistance available on first day BJC Institute for Learning and Development Health Care and Dependent Care Flexible Spending Accounts Paid Time Off benefit combines vacation, sick days, holidays and personal time Adoption assistance To learn more, go to www.bjctotalrewards.com/Benefits *Not all benefits apply to all jobs The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer