Utilization Review Manager - Home Care jobs in Wisconsin

It's more than a career, it's a calling

Job Highlights:

• Department:  Utilization Management

• Patient Population or Ratio: N/A

• Schedule:  Full-time, Monday-Friday, 8:00am-4:30pm  

• Starting Pay:  $71,198.40/annually (Offers are based on years of experience and equity for this role.)

• Shift Differentials:  N/A

• Location:  SSM Health St. Mary's Hospital - Madison, WI

At SSM Health, we believe in providing our employees with a fulfilling career. We strive to create an environment where individuals can grow both personally and professionally. Our company values diversity, innovation, and collaboration, and we are committed to making a positive impact on the communities we serve.

Joining SSM Health means becoming part of a team that is dedicated to providing exceptional patient care and making a difference in people's lives. Our employees are passionate about what they do, and their commitment to our mission is what sets us apart.

The role of the RN-Utilization Review supports our organization by ensuring patients are at the appropriate level of care - this is essential when it comes to insurance coverage for patients.

Job Summary:

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Reviews electronic medical record and screen clinical information with nationally recognized criteria.
• Discusses with payor regarding criteria and payor decision.
• Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration.
• Documents outcome in electronic medical record.
• Active participant with other members of team regarding opportunities for improvement in standard work.
• As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model.
• Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.
• Performs other duties as assigned.

EDUCATION

• Graduate of accredited school of nursing or education equivalency for licensing

EXPERIENCE

• Two years’ registered nurse experience

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 
 
State of Work Location: Illinois 

•     Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) 

     
State of Work Location: Missouri 

•     Registered Nurse (RN) Issued by Compact State  
•     Or 
•     Registered Nurse (RN) - Missouri Division of Professional Registration 

 
State of Work Location: Oklahoma 

•     Registered Nurse (RN) Issued by Compact State  
•     Or 
•     Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) 

     
State of Work Location: Wisconsin 

•     Registered Nurse (RN) Issued by Compact State  
•     Or 
•     Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Work Shift:

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.