RN - Registered Nurse - Utilization Review - PRN Days
About The Position
This position in the Utilization Review Department provides health care services related to admissions, case management, discharge planning, and utilization review. The role involves reviewing admissions and service requests within an assigned unit for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria. The nurse will also provide case management and consultation for complex cases, assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Additionally, the role includes assessing and coordinating discharge planning needs with healthcare team members, preparing statistical analysis and utilization review reports, and 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.
- 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
