Registered Nurse Utilization Review

Ascension•Carmel, IN

3d•$50 - $52•Onsite

About The Position

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.

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.
Utilization Review OR Case Management experience required
Must live locally in Indiana

Nice To Haves

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

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.