RN-Utilization Review

at  Ascension

REQUIREMENTS

Licensure / Certification / Registration:

• Registered Nurse credentialed from the Wisconsin Board of Nursing obtained prior to hire date or job transfer date required. Licensure from the Wisconsin Board of Nursing OR current home state license if considered multi-state/Compact State.

Education:

• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Provide health care services regarding admissions, case management, discharge planning and

utilization review.

• Review admissions and service requests within assigned unit for prospective, concurrent andretrospective medical necessity and/or compliance with reimbursement policy criteria. Provide casemanagement and/or consultation for complex cases.
• Assist departmental staff with issues related to coding, medical records/documentation,precertification, reimbursement and claim denials/appeals.
• Assesse 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 managementrules and regulations.