Registered Nurse Utilization Review
Posted Updated
Description
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Location: Pensacola, FL
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Facility: Ascension Sacred Heart Emerald Coast
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Department: Surgery
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Schedule: Day | PRN
- 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 Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date or job transfer date. Licensed as a Registered Nurse in Florida. Credentialed from State Board of Nursing or current home state license for multi-state license recognition "Compact State" 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.