Utilization Review Manager

­ditional Information About the Role Do you have Clinical and Analytical skills? BJC is looking for a Utilization Review Manager! Overview BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $5.5 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice. BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development. BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country. 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 Qualifications Preferred Requirements Bachelor's Degree in Nursing Benefits Statement Note: not all benefits apply to all openings - Comprehensive medical, dental, life insurance, and disability plan options - Pension Plan*/403(b) Plan - 401(k) plan - Tuition Assistance - Health Care and Dependent Care Reimbursement Accounts - On-Site Fitness Center (depending on location) - Paid Time Off Program for vacation, holiday and sick time *Pension does not apply to Memorial Hospital, Memorial Hospital East, Alton Memorial or Parkland Health Center Legal Statement 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