Registered Nurse Utilization Review

Ascension•Carmel, IN

2d•$50 - $52•Onsite

About The Position

This role is for a Registered Nurse in Utilization Review within the Utilization Management department at Ascension St. Vincent in Indianapolis, IN. The position is PRN, requiring coverage Monday-Friday, including weekends and holidays, with specific training requirements. The nurse will review admissions and service requests for medical necessity and compliance, provide case management, assist with coding and reimbursement issues, coordinate discharge planning, prepare reports, and oversee compliance with utilization management rules and regulations.

Requirements

Registered Nurse credentialed from the Indiana Board of Nursing 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 required.
Active Indiana or compact RN License
Bachelors in Nursing
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care
Utilization Review OR Case Management experience required
Must live locally in Indiana

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.