Registered Nurse RN - Utilization Review

Ascension Health • Pensacola, FL

330d

About The Position

The Utilization Review department at Ascension Sacred Heart Pensacola is seeking a part-time Registered Nurse to provide health care services related to admissions, case management, discharge planning, and utilization review. This position requires a commitment of 24 hours weekly during daytime hours. The role involves reviewing admissions and service requests for medical necessity and compliance with reimbursement policies, providing case management for complex cases, and assisting with coding and documentation issues. The nurse will also assess discharge planning needs and may prepare statistical analyses and reports as necessary, ensuring compliance with mandated utilization management rules.

Requirements

• Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date or job transfer date required.
• Licensed as a Registered Nurse in Florida required.
• Credentialed from State Board of Nursing or current home state license for multi-state license recognition 'Compact State' obtained prior to hire date or job transfer date required.
• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Responsibilities

• 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

• Paid time off (PTO)
• Various health insurance options & wellness plans
• Retirement benefits including employer match plans
• Long-term & short-term disability
• Employee assistance programs (EAP)
• Parental leave & adoption assistance
• Tuition reimbursement
• Ways to give back to your community

What This Job Offers

• Job Type: Part-time
• Career Level: Entry Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: Associate degree