BJC Careers

Utilization Review Coordinator

Saint Louis, MO
Case Coordination


Job Description

Job ID: 1177230
Employment Status: Full-Time
Regular/Temporary: Regular

Your Career. Made Better.

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 mid-Missouri regions. 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.

Revenue Cycle Management (RCM) is the combination of people, processes and technology that will provide BJC patients and families with a seamless, transparent experience through scheduling, authorization, registration, charge capture, billing and collection.  RCM will deliver state-of-the-art integrated workflows and processes enabled by technology to improve all aspects of revenue cycle functions.  This will position BJC with a sustainable advantage and competitive edge in the communities we serve. 


Join Us!


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

     

    Degree

  • Bachelor's Degree
  • - Nursing

     

    Experience

  • 2-5 years
  •  

    Supervisor Experience

  • No Experience
  •  

    Licenses & Certifications

  • RN

  •  

    Preferred Requirements and Additional Job Information

     

    Additional Job Information

  • 40 Hours per Week -
  • Benefits Eligible -

  • 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, Memorial Medical Group, 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