Registered Nurse RN - Utilization Review
About The Position
This position provides health care services regarding admissions, case management, discharge planning, and utilization review. The role involves reviewing admissions and service requests within assigned units for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria. It also includes providing case management and consultation for complex cases, assisting departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Additionally, the role involves assessing and coordinating discharge planning needs with healthcare team members, potentially preparing statistical analysis and utilization review reports, and overseeing compliance with federally mandated and third-party payer utilization management rules and regulations.
Requirements
- Registered Nurse credentialed from the Alabama Board of Nursing obtained prior to hire date or job transfer date required.
- Diploma from an accredited school/college of nursing and required professional licensure at time of hire.
Responsibilities
- Provide health care services regarding admissions, case management, discharge planning and utilization review.
- Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
- Provide case management and/or consultation for complex cases.
- Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Assess and coordinate discharge planning needs with healthcare team members.
- May prepare statistical analysis and utilization review reports as necessary.
- Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Benefits
- generous paid time off
- paid parental leave
- Associate Assistance Program
- Tuition Reimbursement Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
