Registered Nurse Utilization Review

Location: Remote

Facility: Saint Thomas Ascension

Department: Case Management

Schedule: Full-Time | Days

• Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.
• Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
• Assesses and coordinates discharge planning needs with healthcare team members.
• May prepare statistical analysis and utilization review reports as necessary.
• Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.

• Required Credential(s):
  • Registered Nurse obtained prior to hire date or job transfer date.
• Preferred Credential(s):
  • BLS Provider. American Heart Association or American Red Cross accepted.

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