Utilization Review RN

at  Ascension

DETAILS

• Department: Utilization Review
• Schedule: Full-time, 8-hour day shift, Monday-Friday, Remote, including occasional on-site needs, weekends and holidays required
• Facility: Ascension Care Management Insurance

REQUIREMENTS

Licensure / Certification / Registration:

• Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to state in which work is performed.

Education:

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

As the Utilization Review RN, you’ll 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 health-care 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.