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Utilization Review Nurse
2 months ago
We are seeking a skilled Utilization Review RN to join our team at Ascension Saint Thomas. As a Utilization Review RN, you will play a critical role in ensuring that our patients receive the highest quality care while also optimizing our resources.
Responsibilities- Provide health care services regarding admissions, case management, discharge planning, and utilization review.
- Review admissions and service requests within assigned units 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 coordinates 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.
- Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date required.
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Ascension Saint Thomas is a leading healthcare system with a 125-year history of providing care to the community. We are committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable.
We offer a highly comprehensive system of care, with more than 250 sites of care that cover a 45-county area in Tennessee. Our team of over 11,000 dedicated associates care for millions of patients each year.
We are an equal employment opportunity employer and welcome applications from diverse candidates. We are committed to creating a workplace that is inclusive and respectful of all associates and applicants.
