Post job

Utilization review nurse jobs in Missouri

- 293 jobs
  • Nurse Navigator-Specialty (Non-Exempt) (13117N)

    Mercy Health 4.4company rating

    Utilization review nurse job in Springfield, MO

    Find your calling at Mercy!The Nurse Navigator is a leader providing support, mentorship, and guidance to those who provide direct patient care. The Nurse Navigator coordinates the delivery of patient care by assessing care requirements of the individual patient and makes recommendations based on severity of illness, intensity of service and skill level. The Nurse Navigator ensures patients receive timely, safe, effective and high quality care. They coordinate the patient's plan of care with the bedside nurse. The Nurse Navigator sets the expectations regarding professional conduct and serves as a resource for the patient care unit. The Nurse Navigator will hold direct and indirect care providers accountable for their professional responsibilities, and adherence to regulatory guidelines. The Nurse Navigator is responsible for management for the assigned inpatient, and outpatient population. This position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety, and financial components; promoting integration of a seamless care model; coordinating patient discharge planning for post-acute services, length of stay (LOS) management and utilization management; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice. Responsibilities include; pre-op education, daily rounding while the patient is in the hospital, patient discharge disposition, and follow-up care. They perform duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.Position Details: Mercy Clinic Springfield - Gastroenterology Whiteside Full-Time: Monday - Friday Overview: The Nurse Navigator is nursing specialist who follows patients across the continuum of care. The Navigator coordinates with an advanced level of clinical expertise, all aspects of treatment and care for, and in collaboration with, Mercy's patients, their family and significant others, physicians, interdisciplinary team, and other support staff. Qualifications: Experience: 2 years related experience Required Education: Graduate from an approved school of nursing Preferred Education: Bachelor of Science Nursing Certifications: RN (Registered nurse) licensed in state of practice. BLS (Basic Life Support) is required within 30 days of hire is required. Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
    $26k-51k yearly est. 9d ago
  • PA or NP Nocturnist Branson

    Skaggs Community Hospital Association

    Utilization review nurse job in Branson, MO

    :The Nurse Practitioner works in collaboration with a physician for assistance in clinical decision-making, case management and evaluation of performance. The Nurse Practitioner provides advanced nursing care and treatment to patients and performs physical examinations; orders diagnostic tests, develops treatment plans and prescribes drugs or other therapies. The Nurse Practitioner may also plan, direct, or coordinate medicine and health services in hospitals, clinics, managed care organizations, public health agencies, or similar organizations. Education: â–Ş Masters of Science in Nursing Experience: â–Ş Required: No Prior Experience Required â–Ş Preferred: 1-2 years Skills: â–Ş Excellent verbal and written communication skills â–Ş Able to work independently and collaboratively in teams â–Ş Proficient computer skills Licensure/Certification/Registration: â–Ş Required: MO Nurse Practitioner license â–ŞSuccessful completion of all department specific credentialing within first 90 days of employment
    $35k-56k yearly est. 10d ago
  • New Graduate Nurse at Barnes-Jewish Hospital

    BJC 4.6company rating

    Utilization review nurse job in Saint Louis, MO

    Additional Information About the Role The BJC HealthCare New Graduate Nurse position is available for all student nurses - regardless of graduation date - and will connect students directly to our Graduate Nurse recruitment team, who is committed to helping new graduates navigate the Staff Nurse application process. Qualified students who apply to this position are eligible to receive career opportunities at Barnes-Jewish Hospital and across all BJC HealthCare hospitals and nursing specialties. These include: BJC HealthCare Hospital: Alton Memorial Hospital Barnes-Jewish Hospital Barnes-Jewish St. Peters Hospital Barnes-Jewish West County Hospital Christian Hospital Memorial Hospital Belleville Memorial Hospital Shiloh Missouri Baptist Medical Center Missouri Baptist Sullivan Hospital Parkland Health Center Progress West Hospital St. Louis Children's Hospital Nursing Specialty: Cardiovascular Behavioral Health/Psychiatric Critical Care Emergency Home Care Labor & Delivery/Women's Health Medical/Surgical Neurosciences Oncology Operating Room *Medical/Surgical units at BJH offer a $5 Med/Surg differential Available Benefits: $12,500 Sign-On Bonus BSN Differential Benefits Eligible Student-Loan Repayment Eligible at Select Hospital Tuition Assistance Nurse Residency Programs Available at Select Hospitals Do you have questions about your options as student nurse? Connect with our Campus + University Relations Team by emailing us at ...@bjc.org. Not sure if you're ready to apply but want to stay connected? Submit your contact information here: Stay Connected - BJC Health System Overview Barnes-Jewish Hospital is the St. Louis region's top adult hospital. Formed from the merger of the former Barnes and Jewish Hospitals to become Missouri's largest hospital, it continues the traditions of its predecessors along with its partner, Washington University School of Medicine, in providing cutting-edge treatments, educating future medical professionals and working to make our community as healthy as it can be. For over two decades Barnes-Jewish Hospital has been ranked on the U.S. News & World Report Best Hospitals Honor Roll. In 2022, Barnes-Jewish ranked 11 th in the U.S., with 11 specialties being ranked nationally. The hospital was also the first hospital in Missouri to be designated as a Magnet hospital in 2003 by the American Nurses Credentialing Center for excellence in nursing and has been re-designated consistently since. Barnes-Jewish Hospital is a teaching hospital staffed by more than 1,500 Washington University Physicians, the clinical practice for the Washington University School of Medicine. The academic medicine partnership has developed many treatments and procedures that are now common across the globe. We continue to combine science and medicine to tackle some of the toughest diseases while educating future physicians. Barnes-Jewish Hospital is also a safety net hospital for the city of St. Louis when it comes to caring for the under-served and under-insured. For many in our community, the hospital is the only medical care to which they have access, and they are cared for by some of the country's best doctors and nurses. We also serve an incredibly diverse population, including caring for patients from around the world in over 100 different languages, and conducting a wide range of community health education programs in the St. Louis metropolitan area throughout the year. Preferred Qualifications Role Purpose The Graduate Nurse provides direct patient care activities including assessment, diagnosis, planning implementation, and evaluation within the guidelines of the standards of nursing care after completing a nursing program and before licensure. Will be required to obtain licensure within 90 days of graduation from an accredited school of nursing to remain employed in a HSO in the state of Missouri. Responsibilities Educates patients and their families on how to manage their illness or injury, including post treatment home care needs and medication administration. Uses critical thinking skills to assess and evaluate patient's physical, psychosocial and emotional needs. Develops and implements individual plans of care in collaboration with other members of the healthcare team in accordance with the established guidelines and standards of nursing care. Promotes patient and family centered care in a healing environment. Evaluates patient's response and modifies plan of care accordingly throughout the patient's stay. Participates in activities that promote patient safety, quality and regulatory compliance. Participates in professional development. 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. Minimum Requirements Nursing Diploma/Associate's - Nursing Preferred Requirements 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
    $28k-53k yearly est. 8h ago
  • MDS Nurse

    Royalton Manor

    Utilization review nurse job in Saint Joseph, MO

    Are you an experienced registered nurse (RN) who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at Royalton Manor may be just what you're looking for! We will train the right person for the job! At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life Insurance 401K with matching funds Health insurance AFLAC Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include: Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications Active Registered Nurse (RN) license with the state of Michigan AANC certification a plus RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way, Ciena is the place for you! IND123
    $36k-56k yearly est. 21h ago
  • Infusion Nurse - 248326

    Medix™ 4.5company rating

    Utilization review nurse job in Saint Louis, MO

    Full-Time | Monday-Friday | 8:00/8:30 AM - 5:00 PM Pay Range: $40-$50/hr (DOE) Travel Role - Must Have Reliable Transportation A leading ambulatory infusion organization is seeking an experienced Float Infusion Nurse (RN) to support multiple outpatient infusion centers across the St. Louis market. This is a full-time role offering autonomy, consistent weekday hours, and the opportunity for long-term or permanent placement. About the Role The Infusion RN will deliver outpatient infusion therapy to patients with chronic and complex conditions across several specialties, including neurology, rheumatology, gastroenterology, cardiology, and allergy/immunology. This role is ideal for nurses who thrive in a patient-centered, fast-paced infusion environment and enjoy working both independently and within small clinical teams. Key Responsibilities Prepare and administer IV and injectable medications in an outpatient setting. Access and manage central lines (PICC, port-a-cath). Provide patient and caregiver education regarding infusion therapies. Monitor patient response, safety, and treatment progression. Coordinate care with on-site teams, advanced practice providers, and ordering providers. Support daily center operations, including documentation, scheduling, and inventory. Float across multiple St. Louis locations as needed. Utilize WeInfuse EMR. Typical volume: 3-4 infusion chairs per site, 5-6 patients/day, small teams (1-2 RNs). Float Coverage Locations Flexibility available if one or two locations pose challenges. Richmond Heights, MO Ellisville, MO O'Fallon, MO Bridgeton, MO Required Qualifications Active, unencumbered Missouri RN license BSN required BLS (AHA) 2+ years of infusion, ICU, or ER experience (1 year infusion + 1 year other acute care considered) Valid driver's license and car insurance (for travel role) Strong IV therapy and vascular access skills Ability to work autonomously and communicate effectively Preferred Qualifications Ambulatory infusion experience CRNI, VA-BC, OCN certifications Home infusion or specialty infusion experience Soft Skills Strong customer service focus Reliable, punctual, and organized Adaptable to changing site needs Compassionate and patient-centered
    $40-50 hourly 3d ago
  • Graduate Nurse Resident

    Coxhealth 4.7company rating

    Utilization review nurse job in Springfield, MO

    :LIVE OUT YOUR PASSION Check below to see if you have what is needed for this opportunity, and if so, make an application asap. Graduate Nurse Residency CoxHealth is a diverse network of medical professionals caring for the Ozarks. Continuing education is part of our culture of innovation. With over 3,000 nurses serving six hospitals, our graduate nurse residency program is just one way we support new nurses. We also offer help, such as relocation assistance to make the move a bit easier. The graduate nurse residency program is provided throughout your first year as a new nurse and acts as a supplement to the unit-based orientation and clinical classes you attend during your orientation to nursing at CoxHealth. The residency in Springfield is accredited with distinction from the American Nurses Credentialing Center, the highest honor possible for such a program, and the only accredited residency of its kind in southwest Missouri and northwest Arkansas. The nurse residency program is a skill-focused orientation, transitioning into professional development around the fourth month. The program teaches you tools for communication, self-care, and stress management, and offers advice on how to navigate other professional development opportunities, such as our clinical ladder and specialty certification assistance Program Progression takes part in phases: Phase I - A unit-specific orientation with a focus on classroom theory, practicum, clinical time with an experienced preceptor, simulation, and hands-on skills learning. This mandatory phase varies in length depending on the unit and many overlap with Phase II. Phase II - These classes focus on additional skills and specific transition to professional practice topics. Participation is mandatory; classes are offered at a variety of dates and times throughout the month. The program consists of the following nine courses: Patient and nurse outcomes Continuous improvement Critical thinking and delegation Stress Management and self-care Effective communication Informatics, advanced Cerner clinical internet resources Evidence-based practice and research Business and healthcare leadership Professional development opportunities Job Requirements • Education ◦ Required: Graduate of an accredited nursing program or NLN approved program • Experience ◦ No prior experience required • Skills ◦ Excellent verbal and written communication skills ◦ Demonstrate effective leadership abilities ◦ Exhibits valuable time management skills ◦ Strong critical thinking/problem solving skills ◦ Flexibility and ability to work in a multi-tasking environment • Licensure/Certification/Registration ◦ Must take and pass NCLEX exam within 90 days of nursing school graduation ◦ BLS must be obtained within 90 days ◦ Education Required: Graduate of an approved nursing program ◦ Experience No prior experience required ◦ Skills Excellent verbal and written communication skills Demonstrate effective leadership abilities Exhibits valuable time management skills Strong critical thinking/problem solving skills. xevrcyc Flexibility and ability to work in a multi-tasking environment. ◦ Licensure/Certification/Registration Must take and pass NC LEX exam within 90 days of nursing school graduation BLS must be obtained within 90 days
    $43k-53k yearly est. 2d ago
  • Graduate Nurse Resident

    Cox Barton County Hospital

    Utilization review nurse job in Monett, MO

    :LIVE OUT YOUR PASSION Check below to see if you have what is needed for this opportunity, and if so, make an application asap. Graduate Nurse Residency CoxHealth is a diverse network of medical professionals caring for the Ozarks. Continuing education is part of our culture of innovation. With over 3,000 nurses serving six hospitals, our graduate nurse residency program is just one way we support new nurses. We also offer help, such as relocation assistance to make the move a bit easier. The graduate nurse residency program is provided throughout your first year as a new nurse and acts as a supplement to the unit-based orientation and clinical classes you attend during your orientation to nursing at CoxHealth. The residency in Springfield is accredited with distinction from the American Nurses Credentialing Center, the highest honor possible for such a program, and the only accredited residency of its kind in southwest Missouri and northwest Arkansas. The nurse residency program is a skill-focused orientation, transitioning into professional development around the fourth month. The program teaches you tools for communication, self-care, and stress management, and offers advice on how to navigate other professional development opportunities, such as our clinical ladder and specialty certification assistance Program Progression takes part in phases: Phase I - A unit-specific orientation with a focus on classroom theory, practicum, clinical time with an experienced preceptor, simulation, and hands-on skills learning. This mandatory phase varies in length depending on the unit and many overlap with Phase II. Phase II - These classes focus on additional skills and specific transition to professional practice topics. Participation is mandatory; classes are offered at a variety of dates and times throughout the month. The program consists of the following nine courses: Patient and nurse outcomes Continuous improvement Critical thinking and delegation Stress Management and self-care Effective communication Informatics, advanced Cerner clinical internet resources Evidence-based practice and research Business and healthcare leadership Professional development opportunities Job Requirements • Education ◦ Required: Graduate of an accredited nursing program or NLN approved program • Experience ◦ No prior experience required • Skills ◦ Excellent verbal and written communication skills ◦ Demonstrate effective leadership abilities ◦ Exhibits valuable time management skills ◦ Strong critical thinking/problem solving skills ◦ Flexibility and ability to work in a multi-tasking environment • Licensure/Certification/Registration ◦ Must take and pass NCLEX exam within 90 days of nursing school graduation ◦ BLS must be obtained within 90 days ◦ Education Required: Graduate of an approved nursing program ◦ Experience No prior experience required ◦ Skills Excellent verbal and written communication skills Demonstrate effective leadership abilities Exhibits valuable time management skills Strong critical thinking/problem solving skills. xevrcyc Flexibility and ability to work in a multi-tasking environment. ◦ Licensure/Certification/Registration Must take and pass NC LEX exam within 90 days of nursing school graduation BLS must be obtained within 90 days
    $36k-56k yearly est. 2d ago
  • Labor and Delivery - LD RN - Travel Nurse

    Travel Nurse Across America 4.5company rating

    Utilization review nurse job in Perryville, MO

    We're looking for Labor and Delivery RNs for an immediate travel nurse opening in Perryville, MO. The right RN should have 3 years' recent acute care experience. Read below for more requirements. L&D Travel Nurses provide care and support for women before, during and after delivery of a baby. L&D RNs must ensure that the medical as well as emotional needs of their patients are met at all times throughout the birthing process. As an L&D RN, you'll be responsible for assisting physicians when epidurals or pain medications are administered, episiotomies are performed, or when the patient requires preparation for a cesarean delivery. As an L&D Travel Nurse, you should be prepared to perform the following tasks: Stay with and monitor patient throughout labor. Monitor contractions and help patients with breathing techniques. Check cervix periodically to monitor progression/lack of dilation. Ensure beds are kept clean and dry; clean up bodily fluids expelled before and after birthing process. Aid physician with drapes, gloves, gowns, delivery instruments, etc. Immediate care of newborn. L&D Travel Nurses should be able to stand and walk for long periods of time, as well as bend, lean and stoop without difficulty. RNs should be able to easily lift 20 pounds. Moving or lifting of patients may require lifting of up to 50 pounds at times. Because of the fast-paced environment, L&D RNs must possess good skills for coping with stress and be able to relate to people of all ages and backgrounds. Requirements*: BLS, NRP, 2 Years * Additional certifications may be required before beginning an assignment.
    $62k-124k yearly est. 10h ago
  • Nurse Navigator-Specialty (Non-Exempt) (13117N)

    Mercy 4.5company rating

    Utilization review nurse job in Springfield, MO

    Find your calling at Mercy! The Nurse Navigator is a leader providing support, mentorship, and guidance to those who provide direct patient care. The Nurse Navigator coordinates the delivery of patient care by assessing care requirements of the individual patient and makes recommendations based on severity of illness, intensity of service and skill level. The Nurse Navigator ensures patients receive timely, safe, effective and high quality care. They coordinate the patient's plan of care with the bedside nurse. The Nurse Navigator sets the expectations regarding professional conduct and serves as a resource for the patient care unit. The Nurse Navigator will hold direct and indirect care providers accountable for their professional responsibilities, and adherence to regulatory guidelines. The Nurse Navigator is responsible for management for the assigned inpatient, and outpatient population. This position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety, and financial components; promoting integration of a seamless care model; coordinating patient discharge planning for post-acute services, length of stay (LOS) management and utilization management; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice. Responsibilities include; pre-op education, daily rounding while the patient is in the hospital, patient discharge disposition, and follow-up care. They perform duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.Position Details: Mercy Clinic Springfield - Gastroenterology Whiteside Full-Time: Monday - Friday Overview: The Nurse Navigator is nursing specialist who follows patients across the continuum of care. The Navigator coordinates with an advanced level of clinical expertise, all aspects of treatment and care for, and in collaboration with, Mercy's patients, their family and significant others, physicians, interdisciplinary team, and other support staff. Qualifications: Experience: 2 years related experience Required Education: Graduate from an approved school of nursing Preferred Education: Bachelor of Science Nursing Certifications: RN (Registered nurse) licensed in state of practice. BLS (Basic Life Support) is required within 30 days of hire is required. Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
    $30k-52k yearly est. 3h ago
  • Staff Nurse - Turner Center Urgent Care

    L.E. Cox Medical Centers 4.4company rating

    Utilization review nurse job in Springfield, MO

    :The Urgent Care nurse provides professional nursing care during the initial phase of acute illness or trauma for patients of all ages. The UC nurse triages and determines priority of care based on physical, psychological and social needs as well as factors influencing patient flow through the emergency care system. The UC nurse works quickly to assess the needs of each patient, prioritize care based on the critical nature, works to stabilize the patient, initiate treatment, discharge the patient after the emergency is over or make arrangements for a longer hospital stay.Education: Required: Graduate of an accredited nursing program or NLN approved program Preferred: Bachelor's Degree in Nursing Please double check you have the right level of experience and qualifications by reading the full overview of this opportunity below. Experience: Preferred: Previous nursing experience Skills: Excellent verbal and written communication skills Demonstrate effective leadership abilities Exhibits valuable time management skills Strong critical thinking/problem solving skills. xevrcyc Flexibility and ability to work in a multi-tasking environment. Licensure/Certification/Registration: Required: RN license active in the state of Missouri Required: Must obtain ENPC within 3 years of hire
    $29k-54k yearly est. 2d ago
  • Utilization Review Coordinator

    Perimeter Healthcare

    Utilization review nurse job in Springfield, MO

    Perimeter Behavioral of Springfield has an immediate opening for a Full-Time Utilization Review Coordinator. We are seeking individuals who are committed to improving the lives of those with mental health illness. Perimeter Behavioral of Springfield is one of the premier behavioral health hospitals providing inpatient psychiatric treatment for children and teenagers. Comprehensive care is designed for the individual, not the diagnosis. Perimeter Behavioral of Springfield is daily committed to improving patients' lives by using a patient centered collaborative approach to provide high quality care addressing both the mental health and physical wellbeing of our patients. Join our team today! The Utilization Review Coordinator responsibilities include the following: * Within two working days of admission, obtains initial certification based on established Severity of Illness/Intensity of Service criteria. * Performs initial coding of admitting diagnosis and calculated tentative DRG and length of stay assignment * Conducts concurrent and/or retrospective review of the patient record as required by the payor. The review includes but is not limited to 1) timeliness of delivery of all ordered services; 2) adequate documentation in the Medical Record of services delivered; 3) appropriate utilization of resources; 4) communication to the physicians of average length of stays as determined by the payor. * Is knowledgeable of criteria for Medicare, Medicaid, managed care and private insurance coverage. * Communicates daily with admissions personnel regarding admissions and discharges to various units. * Is knowledgeable of patient's financial status, diagnosis and discharge needs. * Assist Social Services and physicians to facilitate the timely transfer of patients with appropriate follow-up care. * Acts on performance improvement issues identified during patient conferences and Utilization Review meetings. * Maintains and respects confidentiality of patient/physician/personnel information * Assists Patient Finance Department with audits and surveys conducted by third party payors. * Serve as liaison to Primaris, Medical Review Services, and agencies having insurance payment contracts. * Assist physicians with appeal process for denials. * Provides data as requested by the Utilization Review committee or any of its members. Quarterly report readmissions within 30 days, transfers to other acute care facilities, and prolonged lengths of stay. * Actively participates in Utilization Review Committee, performance improvement, varying team meetings and other meetings as appropriate. * Ensures Hospital Review Plan meets criteria set forth by Medicare, Medicaid and third party payors. * Demonstrates an ability to be flexible, organized and function under stressful situations. * Consults other departments as appropriate to collaborate on patient care and performance improvement activities. * Documentation meets current standards and policies. Qualified candidates for Utilization Review Coordinator should have the following: * Must be at least 21 years of age * Graduate of an Accredited School of Practical Nursing or Registered Nursing. * Bachelor of Science degree in Nursing or at least a minimum of five (5) years' nursing experience in the hospital setting with broad clinical experience and knowledge * Experience: Working knowledge of criteria for Medicare, Medicaid, managed care and private insurance coverage * Current nursing licensure in the State of Missouri * Possess and maintain current CPR certification * Schedule: Full-Time Monday - Friday, 8-hour shifts Our Full-Time benefits include the following: * 401(k) plan and company match * Health Insurance * Dental Insurance * Vision Insurance * Life Insurance * Paid Time Off * Employee Assistance Program * Supplemental Insurance Plans Available #INDSFIELD
    $43k-65k yearly est. 24d ago
  • Graduate Nurse Resident (FT Days)

    Mercy Health 4.4company rating

    Utilization review nurse job in Springfield, MO

    Find your calling at Mercy!Performs direct patient care activities for all age groups to include assessment, planning, implementation, and evaluation. Monitors and coordinates patient care activities with ancillary departments to optimize patient care and comfort. Functions within the scope of nursing preparation and consistent with the established guidelines of nursing practice, the goals of Mercy Health System, the Philosophy of the Sisters of Mercy, the Arkansas Nurse Practice Act, the Code of Professional and Business Ethics and the Co-Worker Code of Conduct. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.Position Details: Graduate Nurse Sign On Bonus $5,000 Experienced RN Sign On Bonus up to $20,000 PTO Frontload up to 80 hours for full time experienced RN's Up to $3000 Relocation Assistance for full time only Graduate RN Student Loan Forgiveness!! The 4B Cardiac Unit, comprised of 31 beds, focuses on adult Cardiac patient, Drug loading, post Angio, CHF, vascular and medical patients. Shift schedules include days (0700-1900) and nights (1900-0700), with weekend rotation every 2 weeks. Clinical skills include: Telemetry Monitoring Pacemaker/ICA Care Post Angio Care TR Band BiPap 5 Main Medication Drips Qualifications: Education: Graduate of a state approved professional nurse program. Licensure: Current RN licensure with Missouri State Board of Nursing or current RN Missouri temporary work permit Certifications: Must have a current American Heart Association Healthcare Provider card or complete a course within their probation period. Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
    $26k-51k yearly est. 9d ago
  • Graduate Nurse Minimally Invasive PCU

    BJC 4.6company rating

    Utilization review nurse job in Saint Louis, MO

    Additional Information About the Role The General Surgery floor is located on north campus in the Schoenberg Pavilion and is a bariatric center of excellence. The nurses care for patients who undergo innovative surgeries including plastic reconstruction, minimally invasive surgery, endocrine oncology, and ophthalmology. Staff care for a variety of patients, including those experiencing minimally invasive, endocrine oncology, plastic reconstruction, orthopedics, ophthalmology, or bariatric surgeries. Our bariatric program is accredited as a Center of Excellence. We see patients from around the world who come to us for nerve and tendon transfers. You will constantly learn and grow in this ever changing environment. BSN and ADN candidates welcome to apply! • The BJC RN Career Ladder differentiates BJC as the place for nurses to work in the greater St. Louis area. • This is a tool to empower nurses to work at the top of their license and own their career progression. • The BJC RN Career Ladder promotes professional development, leadership, collaboration, education and service excellence and gives staff the opportunity to continue doing what they do best - caring for patients - while having the opportunity to advance to the next step in their career. • Moves to higher ladder levels will result in a percentage increase of current pay that aligns with the new job description. Overview Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and is ranked as one of the nation's top hospitals by U.S. News & World Report. Barnes-Jewish Hospital's staff is composed of full-time academic faculty and community physicians of Washington University School of Medicine, supported by a house staff of residents, interns, fellows and other medical professionals. Recognizing its excellence in nursing care, Barnes-Jewish Hospital was the first adult hospital in Missouri to be certified as a Magnet Hospital by the American Nurses Credentialing Center. 4900 General Surgery cares for a wide variety of patients including Minimally Invasive Surgery, Bariatric, Plastic Reconstruction, Endocrine-oncology, Orthopedics and Opthalmology. We are recognized as a Bariatric Center of Excellence. The various surgical services that comprise our patient population make 4900 a dynamic floor on which to build your nursing skillset. Preferred Qualifications Role Purpose The Graduate Nurse provides direct patient care activities including assessment, diagnosis, planning implementation, and evaluation within the guidelines of the standards of nursing care after completing a nursing program and before licensure. Will be required to obtain licensure within 90 days of graduation from an accredited school of nursing to remain employed in a HSO in the state of Missouri. Responsibilities Promotes patient and family centered care in a healing environment. Educates patients and their families on how to manage their illness or injury, including post treatment home care needs and medication administration. Uses critical nursing skills to assess and evaluate patient's physical, psychosocial and emotional needs. Develops and implements individual plans of care in collaboration with other members of the healthcare team in accordance with the established guidelines and standards of nursing care. Evaluates patient's response and modifies plan of care accordingly throughout the patient's stay. Participates in activities that promote patient safety, quality and regulatory compliance. Participates in professional development. Minimum Requirements Education Nursing Diploma/Associate's - Nursing Experience No Experience Supervisor Experience No Experience 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
    $28k-53k yearly est. 8h ago
  • Adult Psych - Staff Nurse

    Coxhealth 4.7company rating

    Utilization review nurse job in Springfield, MO

    for Qualified Candidates Make sure to apply quickly in order to maximise your chances of being considered for an interview Read the complete job description below. • Up to $10,000 Sign-On Bonus • Up to 80 hours of front-loaded Paid Time Off • Up to $3,000 Relocation bonus • Career Ladder up to $5,000 Job Requirements • Education ◦ Required: Graduate of an accredited nursing program or NLN approved program ◦ Preferred: Bachelor's Degree in Nursing • Experience ◦ Preferred: Previous nursing experience • Skills ◦ Excellent verbal and written communication skills ◦ Demonstrate effective leadership abilities ◦ Exhibits valuable time management skills ◦ Strong critical thinking/problem-solving skills. ◦ Flexibility and ability to work in a multitasking environment. • Licensure/Certification/Registration ◦ Required: RN license active in the state of Missouri ◦ Required: BLS must be obtained within 90 day Education: Required: Graduate of an accredited nursing program or NLN approved program Preferred: Bachelor's Degree in Nursing Experience: Preferred: Previous nursing experience Skills: Excellent verbal and written communication skills Demonstrate effective leadership abilities Exhibits valuable time management skills Strong critical thinking/problem solving skills. xevrcyc Flexibility and ability to work in a multi-tasking environment. Licensure/Certification/Registration: Required: RN license active in the state of Missouri
    $47k-56k yearly est. 2d ago
  • Graduate Nurse Resident

    Skaggs Community Hospital Association

    Utilization review nurse job in Branson, MO

    :LIVE OUT YOUR PASSION Check below to see if you have what is needed for this opportunity, and if so, make an application asap. Graduate Nurse Residency CoxHealth is a diverse network of medical professionals caring for the Ozarks. Continuing education is part of our culture of innovation. With over 3,000 nurses serving six hospitals, our graduate nurse residency program is just one way we support new nurses. We also offer help, such as relocation assistance to make the move a bit easier. The graduate nurse residency program is provided throughout your first year as a new nurse and acts as a supplement to the unit-based orientation and clinical classes you attend during your orientation to nursing at CoxHealth. The residency in Springfield is accredited with distinction from the American Nurses Credentialing Center, the highest honor possible for such a program, and the only accredited residency of its kind in southwest Missouri and northwest Arkansas. The nurse residency program is a skill-focused orientation, transitioning into professional development around the fourth month. The program teaches you tools for communication, self-care, and stress management, and offers advice on how to navigate other professional development opportunities, such as our clinical ladder and specialty certification assistance Program Progression takes part in phases: Phase I - A unit-specific orientation with a focus on classroom theory, practicum, clinical time with an experienced preceptor, simulation, and hands-on skills learning. This mandatory phase varies in length depending on the unit and many overlap with Phase II. Phase II - These classes focus on additional skills and specific transition to professional practice topics. Participation is mandatory; classes are offered at a variety of dates and times throughout the month. The program consists of the following nine courses: Patient and nurse outcomes Continuous improvement Critical thinking and delegation Stress Management and self-care Effective communication Informatics, advanced Cerner clinical internet resources Evidence-based practice and research Business and healthcare leadership Professional development opportunities Job Requirements • Education ◦ Required: Graduate of an accredited nursing program or NLN approved program • Experience ◦ No prior experience required • Skills ◦ Excellent verbal and written communication skills ◦ Demonstrate effective leadership abilities ◦ Exhibits valuable time management skills ◦ Strong critical thinking/problem solving skills ◦ Flexibility and ability to work in a multi-tasking environment • Licensure/Certification/Registration ◦ Must take and pass NCLEX exam within 90 days of nursing school graduation ◦ BLS must be obtained within 90 days ◦ Education Required: Graduate of an approved nursing program ◦ Experience No prior experience required ◦ Skills Excellent verbal and written communication skills Demonstrate effective leadership abilities Exhibits valuable time management skills Strong critical thinking/problem solving skills. xevrcyc Flexibility and ability to work in a multi-tasking environment. ◦ Licensure/Certification/Registration Must take and pass NC LEX exam within 90 days of nursing school graduation BLS must be obtained within 90 days
    $35k-56k yearly est. 2d ago
  • Graduate Nurse Resident (FT Days)

    Mercy 4.5company rating

    Utilization review nurse job in Springfield, MO

    Find your calling at Mercy! Performs direct patient care activities for all age groups to include assessment, planning, implementation, and evaluation. Monitors and coordinates patient care activities with ancillary departments to optimize patient care and comfort. Functions within the scope of nursing preparation and consistent with the established guidelines of nursing practice, the goals of Mercy Health System, the Philosophy of the Sisters of Mercy, the Arkansas Nurse Practice Act, the Code of Professional and Business Ethics and the Co-Worker Code of Conduct. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.Position Details: Graduate Nurse Sign On Bonus $5,000 Experienced RN Sign On Bonus up to $20,000 PTO Frontload up to 80 hours for full time experienced RN's Up to $3000 Relocation Assistance for full time only Graduate RN Student Loan Forgiveness The 4B Cardiac Unit, comprised of 31 beds, focuses on adult Cardiac patient, Drug loading, post Angio, CHF, vascular and medical patients. Shift schedules include days () and nights (), with weekend rotation every 2 weeks. Clinical skills include: Telemetry Monitoring Pacemaker/ICA Care Post Angio Care TR Band BiPap 5 Main Medication Drips Qualifications: Education: Graduate of a state approved professional nurse program. Licensure: Current RN licensure with Missouri State Board of Nursing or current RN Missouri temporary work permit Certifications: Must have a current American Heart Association Healthcare Provider card or complete a course within their probation period. Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
    $30k-52k yearly est. 3h ago
  • Utilization Review Coordinator

    Perimeter Healthcare

    Utilization review nurse job in Springfield, MO

    Job Description Perimeter Behavioral of Springfield has an immediate opening for a Full-Time Utilization Review Coordinator. We are seeking individuals who are committed to improving the lives of those with mental health illness. Perimeter Behavioral of Springfield is one of the premier behavioral health hospitals providing inpatient psychiatric treatment for children and teenagers. Comprehensive care is designed for the individual, not the diagnosis. Perimeter Behavioral of Springfield is daily committed to improving patients' lives by using a patient centered collaborative approach to provide high quality care addressing both the mental health and physical wellbeing of our patients. Join our team today! The Utilization Review Coordinator responsibilities include the following: Within two working days of admission, obtains initial certification based on established Severity of Illness/Intensity of Service criteria. Performs initial coding of admitting diagnosis and calculated tentative DRG and length of stay assignment Conducts concurrent and/or retrospective review of the patient record as required by the payor. The review includes but is not limited to 1) timeliness of delivery of all ordered services; 2) adequate documentation in the Medical Record of services delivered; 3) appropriate utilization of resources; 4) communication to the physicians of average length of stays as determined by the payor. Is knowledgeable of criteria for Medicare, Medicaid, managed care and private insurance coverage. Communicates daily with admissions personnel regarding admissions and discharges to various units. Is knowledgeable of patient's financial status, diagnosis and discharge needs. Assist Social Services and physicians to facilitate the timely transfer of patients with appropriate follow-up care. Acts on performance improvement issues identified during patient conferences and Utilization Review meetings. Maintains and respects confidentiality of patient/physician/personnel information Assists Patient Finance Department with audits and surveys conducted by third party payors. Serve as liaison to Primaris, Medical Review Services, and agencies having insurance payment contracts. Assist physicians with appeal process for denials. Provides data as requested by the Utilization Review committee or any of its members. Quarterly report readmissions within 30 days, transfers to other acute care facilities, and prolonged lengths of stay. Actively participates in Utilization Review Committee, performance improvement, varying team meetings and other meetings as appropriate. Ensures Hospital Review Plan meets criteria set forth by Medicare, Medicaid and third party payors. Demonstrates an ability to be flexible, organized and function under stressful situations. Consults other departments as appropriate to collaborate on patient care and performance improvement activities. Documentation meets current standards and policies. Qualified candidates for Utilization Review Coordinator should have the following: Must be at least 21 years of age Graduate of an Accredited School of Practical Nursing or Registered Nursing. Bachelor of Science degree in Nursing or at least a minimum of five (5) years' nursing experience in the hospital setting with broad clinical experience and knowledge Experience: Working knowledge of criteria for Medicare, Medicaid, managed care and private insurance coverage Current nursing licensure in the State of Missouri Possess and maintain current CPR certification Schedule: Full-Time Monday - Friday, 8-hour shifts Our Full-Time benefits include the following: 401(k) plan and company match Health Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off Employee Assistance Program Supplemental Insurance Plans Available #INDSFIELD Powered by JazzHR cDyhFxAOSy
    $43k-65k yearly est. 14d ago
  • Staff Nurse - Urgent Care Nixa

    L.E. Cox Medical Centers 4.4company rating

    Utilization review nurse job in Nixa, MO

    :The Urgent Care nurse provides professional nursing care during the initial phase of acute illness or trauma for patients of all ages. The UC nurse triages and determines priority of care based on physical, psychological, or social needs as well as factors influencing patient flow through the emergency care system. The UC nurse works quickly to assess the needs of each patient, prioritize care based on the critical nature, works to stabilize the patient, initiate treatment, discharge the patient after the emergency is over or make arrangements for a longer hospital stay.Education: Required: Graduate of an accredited nursing program Preferred: Bachelor's Degree in Nursing Find out more about this role by reading the information below, then apply to be considered. Experience: Preferred: Previous nursing experience Skills: Excellent verbal and written communication skills Demonstrate effective xevrcyc leadership abilities Exhibits valuable time management skills Strong critical thinking/problem solving skills Flexibility and ability to work in a multi-tasking environment Licensure/Certification/Registration: Required: Nursing License active in the state of Missouri
    $29k-55k yearly est. 2d ago
  • vICU Nurse (Non-Exempt)

    Mercy Health 4.4company rating

    Utilization review nurse job in Chesterfield, MO

    Find your calling at Mercy!Provides TeleICU (eICU) nursing care to a diverse population of critically ill ICU patients across multiple hospitals. Collects data and provides tele-nursing care. Assesses, and collaborates with other TeleICU personnel and the bedside team via audio/video connections during patients ICU stay to achieve optimal patient outcomes. Discusses patient care issues with physicians and other health care team members. Maintains professional accountability for provision of patient care for the assigned patients. Maintains patient rights and confidentiality of patient information. Performs duties and responsibilities in a manner consistent our mission, values and Mercy Service Standards.Position Details: Minimum Qualifications: Education: Must have either a current RN Temporary Permit/RN license in the state of practice Licensure: State Licensure in state of practice & Multi-state licensure required within 6 months of hire. Experience: Minimum 2 years recent ICU nursing experience Certifications: CPR required ACLS required. Preferred Qualifications Education: BSN. Experience: Charge nurse experience. Knowledge, Skills, and Abilities: - Requires excellent communication skills and able to collaborate effectively within a team environment. - Must have the ability to independently practice and prioritize demands in an ever-changing, dynamic environment. - Must demonstrate understanding of pathophysiology and common problems and solutions associated with adult ICU patients. Physical Requirements: - The physical demands described here are the representative of the minimums that must be met by an employee to perform all essential functions of the job. Most physical demands are below, plus: - Minimal: push/pull < 10 lbs. force; grip; pinch grip, Frequent: hand coordination Continuous: data entry Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
    $25k-51k yearly est. 2d ago
  • New Graduate Nurse at Missouri Baptist Sullivan Hospital

    BJC 4.6company rating

    Utilization review nurse job in Sullivan, MO

    Additional Information About the Role The BJC HealthCare New Graduate Nurse position is available for all student nurses - regardless of graduation date - and will connect students directly to our Graduate Nurse recruitment team, who is committed to helping new graduates navigate the Staff Nurse application process. Qualified students who apply to this position are eligible to receive career opportunities at Missouri Baptist Sullivan Hospital and across all BJC HealthCare hospitals and nursing specialties. These include: BJC HealthCare Hospital: Alton Memorial Hospital Barnes-Jewish Hospital Barnes-Jewish St. Peters Hospital Barnes-Jewish West County Hospital Christian Hospital Memorial Hospital Belleville Memorial Hospital Shiloh Missouri Baptist Medical Center Missouri Baptist Sullivan Hospital Parkland Health Center Progress West Hospital St. Louis Children's Hospital Nursing Specialty: Cardiovascular Behavioral Health/Psychiatric Critical Care Emergency Home Care Labor & Delivery/Women's Health Medical/Surgical Neurosciences Oncology Operating Room Pediatrics Available Benefits: BSN Differential Benefits Eligible Student-Loan Repayment Eligible at Select Hospital Tuition Assistance Nurse Residency Programs Available at Select Hospitals Do you have questions about your options as student nurse? Connect with our Campus + University Relations Team by emailing us at ...@bjc.org. Not sure if you're ready to apply but want to stay connected? Submit your contact information here: Stay Connected - BJC Health System Overview Missouri Baptist Sullivan Hospital is a designated critical access hospital committed to providing quality health care service to residents in Crawford, Franklin and Washington counties. The hospital has enhanced and expanded the health care services available to the greater Sullivan community with its state-of-the-art emergency department, modern childbirth center, critical care unit, multiroom surgical suite, expanded cardiac rehab services, and a cancer center. A 22,500 square-foot medical office building provides offices for primary care physicians as well as space for a variety of visiting medical and surgical specialists from the St. Louis area. Missouri Baptist Sullivan Hospital operates four rural health clinics providing quality health care to surrounding communities. In addition, the hospital operates a comprehensive Therapy and Rehabilitation department and an award-winning Wound Care Center with two hyperbaric chambers. Preferred Qualifications Role Purpose The Graduate Nurse provides direct patient care activities including assessment, diagnosis, planning implementation, and evaluation within the guidelines of the standards of nursing care after completing a nursing program and before licensure. Will be required to obtain licensure within 90 days of graduation from an accredited school of nursing to remain employed in a HSO in the state of Missouri. Responsibilities Educates patients and their families on how to manage their illness or injury, including post treatment home care needs and medication administration. Uses critical thinking skills to assess and evaluate patient's physical, psychosocial and emotional needs. Develops and implements individual plans of care in collaboration with other members of the healthcare team in accordance with the established guidelines and standards of nursing care. Promotes patient and family centered care in a healing environment. Evaluates patient's response and modifies plan of care accordingly throughout the patient's stay. Participates in activities that promote patient safety, quality and regulatory compliance. Participates in professional development. 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. Minimum Requirements Nursing Diploma/Associate's - Nursing Preferred Requirements 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
    $28k-53k yearly est. 8h ago

Learn more about utilization review nurse jobs

Do you work as a utilization review nurse?

What are the top employers for utilization review nurse in MO?

Actalent

Centerwell

Centurion Health

Top 4 Utilization Review Nurse companies in MO

  1. BJC HealthCare

  2. Actalent

  3. Centerwell

  4. Centurion Health

Job type you want
Full Time
Part Time
Internship
Temporary

All utilization review nurse jobs

Jobs in Missouri