Great remote Registered Nurse opportunity supporting clinical appeals!
Write clinical appeals for post patient hospital treatment insurance denials.
Utilize work queues in EPIC, write and submit 10 to 12 clinical appeals letters daily.
Work Schedule
Monday - Friday 8 hours per day; some flexibility
Local Remote in the Missouri and Illinois area
Some meetings at office in commons; able to work from Commons if desired
Requirements
RN license
At least 2 years of RN experience, in-patient or case management preferred
BSN preferred
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 $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 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.
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.
Minimum Requirements
Education
Nursing Diploma/Associate's
- Nursing
Experience
2-5 years
Supervisor Experience
No Experience
Licenses & Certifications
RN
Preferred Requirements
Education
Bachelor's Degree
- 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
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