Prior Authorization Coordination RN in St. Louis, MO

Additional Information About the Role Location: St. Louis Children's Hospital One Children's Place St. Louis, MO 63110 • Benefits eligible • Full-time; 40 hours per week • Monday - Friday; generally 7:00am-4:00pm • No weekends or holidays Role Responsibilities: • Engage with various clinics to ensure proper level of care is pre-certified prior to admission. • Run and review reports for out of network or out of state Medicaid plans and escalate to appropriate team members to initiate contracting. • Collaborate with transplant and surgical service lines for upcoming admissions and high dollar inpatient stays. Additional Preferred Requirements • 2 years of RN experience • 1 year of Utilization Review/Utilization Management experience • Prior hospital-based/provider office authorization experience Overview St. Louis Children’s Hospital is dedicated to improving the health and lives of children. As one of the top-ranked children’s hospitals in the country, St. Louis Children’s provides care in more than 50 specialty areas through a dedicated team of physicians, nurses, staff and volunteers. Along with inpatient and outpatient medical care, the hospital offers education, wellness and injury-prevention programs to fulfill its mission to “do what’s right for kids.” Providing comprehensive, high-quality care and serving as an advocate for children has been St. Louis Children’s commitment since its inception in 1879. Today, the hospital serves patients and families across a 300-mile service area, and has seen patients from all 50 states and more than 80 countries. St. Louis Children’s consistently ranks among America’s Best Children’s Hospitals by U.S.News & World Report in all surveyed categories. In 2021, St. Louis Children’s was one of eight children’s hospitals to rank in the top 25 of all 10 specialties. The hospital’s academic and physician partner, Washington University School of Medicine, is one of the top-ranked medical schools in the United States. Since 2005, St. Louis Children’s has been designated as a Magnet® hospital for nursing excellence from the American Nurses Credentialing Center® (ANCC). 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 • Annual 4% BJC Automatic Retirement Contribution • 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 our Benefits Summary. • 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