Registered Nurse RN - Utilization Review
About The Position
This role involves providing healthcare services related to admissions, case management, discharge planning, and utilization review. The Registered Nurse will review admissions and service requests within their assigned unit for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria. They will also provide case management and consultation for complex cases, assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Additionally, the role includes assessing and coordinating discharge planning needs with healthcare team members, preparing statistical analysis and utilization review reports as necessary, 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.
Nice To Haves
- No additional preferences.
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
Number of Employees
5,001-10,000 employees
