Registered Nurse RN - Utilization Review

Job description

Position Overview: - Department: Utilization Management - Schedule: M- F (4 10's or 5 8's) - Work Location: remote covering all STV facilities - Benefits for eligible positions only include: generous paid time off, paid parental leave, Associate Assistance Program, Tuition Reimbursement Program, and more What You Will Do: 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 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 management rules and regulations. What You Will Need: Education: - Registered Nurse credentialed from the Alabama Board of...