Evaluates insurance coverage while managing the utilization review process from admission to discharge. Completes and updates medical records pertaining to case management and authorizations. This position
participates in a multidisciplinary palliative care team.
Joins with treatment team in reviewing comprehensive patient/ family treatment plan.
Collaborates with physicians and other health care professional regarding patient plan of care and intermediate care goals within proposed time line.
Reviews and evaluates discharge planning on all clients while scheduling follow-up appointments.
Evaluates insurance coverage for optimal use of benefits while managing the utilization process from admission to discharge.
Interviews patient / family members, obtain a complete initial social history including financial information, and communicate with external case managers to receive authorization of payment.
Performs all other duties according to entity policies/procedures as assigned.
Associate Degree or Diploma School Program
Required -State of Missouri Nursing License; Preferred – BSN and UR, QA, or CM certification
1 to 3 years of experience
The 525-bed SSM Health St. Mary's Hospital - St. Louis is a major teaching hospital affiliated with the Saint Louis University Department of Obstetrics and Gynecology. St. Mary's Hospital - St. Louis offers a wide variety of outpatient services, including cardiovascular and open-heart surgery, high-risk obstetrics and comprehensive women's breast health services. The hospital was recognized with the 2008 and 2010 Premier Award for Quality.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same