**It's more than a career, it's a calling.** MO-REMOTE **Worker Type:** Regular **Job Summary:** Ensure payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Reviews electronic medical record and screen clinical information with nationally recognized criteria. + Discusses with payor regarding criteria and payor decision. + Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration. + Documents outcome in electronic medical record. + Active participant with other members of team regarding opportunities for improvement in standard work. + As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. + Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations. + Performs other duties as assigned. EDUCATION + Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE + Two years’ registered nurse experience REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois + Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse (RN) Issued by Compact State + Or + Registered Nurse (RN) - Missouri Division of Professional Registration State of Work Location: Oklahoma + Registered Nurse (RN) Issued by Compact State + Or + Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin + Registered Nurse (RN) Issued by Compact State + Or + Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services **Work Shift:** Day Shift (United States of America) **Job Type:** Employee **Department:** 8764070033 System Care Coordination **Scheduled Weekly Hours:** 40 **Benefits:** SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. + **Paid Parental Leave** **:** we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). + **Flexible Payment Options:** our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. + **Upfront Tuition Coverage** : we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits (https://jobs.ssmhealth.com/us/en/benefits) _SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,_ _pregnancy, veteran status_ **_,_** _or any other characteristic protected by applicable law. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)_