RN - Registered Nurse - Utilization Review - PRN Days
About The Position
The Registered Nurse - Utilization Review position is part of the Utilization Review department and operates on a PRN Days schedule at UAB St. Vincent's Birmingham. This role involves providing health care services related to admissions, case management, discharge planning, and utilization review. The nurse will review admissions and service requests for medical necessity and compliance with reimbursement policies, offering case management and consultation for complex cases. Additionally, the role supports departmental staff with coding, documentation, precertification, reimbursement, and claim denial issues. The nurse will also assess and coordinate discharge planning needs and may prepare utilization review reports. A key aspect of the role is overseeing compliance with federally mandated and third-party payer utilization management rules and regulations.
Requirements
- Licensed Associate Professional 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.
- One Year of Experience is required.
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
Career Level
Mid Level
Education Level
Associate degree
