Registered Nurse Utilization Review

Ascension•Jacksonville, FL

2h•$84,061 - $118,669•Remote

About The Position

Lead the end-to-end medical necessity review process, ensuring admissions and service requests meet all reimbursement and compliance criteria. Provide expert case management and consultation for high-complexity cases to optimize patient outcomes. Resolve departmental hurdles related to coding, documentation, and precertification while navigating the claims and appeals process. Strategize with the healthcare team to assess and execute seamless discharge plans tailored to patient needs. Spearhead compliance with federal and third-party payer regulations, leveraging data and utilization reports to drive operational excellence.

Requirements

Licensed Registered Nurse obtained prior to hire date or job transfer date.
Licensed as a Registered Nurse in Florida.
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 required.

Responsibilities

Lead the end-to-end medical necessity review process, ensuring admissions and service requests meet all reimbursement and compliance criteria.
Provide expert case management and consultation for high-complexity cases to optimize patient outcomes.
Resolve departmental hurdles related to coding, documentation, and precertification while navigating the claims and appeals process.
Strategize with the healthcare team to assess and execute seamless discharge plans tailored to patient needs.
Spearhead compliance with federal and third-party payer regulations, leveraging data and utilization reports to drive operational excellence.