Registered Nurse Utilization Review
Posted Updated
Location: Remote
Facility: Ascension St Thomas
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):
- Licensed Compact State Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date.
- Diploma from an accredited school/college of nursing required. OR Required professional licensure at time of hire.