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RN Utilization Review Specialist
2 months ago
We are seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for reviewing admissions and service requests to ensure medical necessity and compliance with reimbursement policy criteria.
Responsibilities- Provide healthcare 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 coordinate discharge planning needs with healthcare team members.
- 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.
- Registered Nurse credentialed from the Wisconsin Board of Nursing obtained prior to hire date or job transfer date required.
- Licensure from the Wisconsin Board of Nursing or current home state license if considered multi-state/Compact State.
- Diploma from an accredited school/college of nursing or required professional licensure at time of hire.
- Previous experience and efficiency in utilization management required.
- Strong computer literacy preferred.
Ascension Wisconsin has been providing rewarding careers to healthcare professionals since 1848. We operate 17 hospital campuses and over 100 related healthcare facilities from Racine to Appleton, offering opportunities to create a career path you love, all while delivering compassionate, personalized care to the communities we serve.
Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.
Our Mission, Vision, and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer, and make a positive impact in their community.
Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
Equal Employment Opportunity Employer
Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status, or any other legally protected status or status as a covered veteran in accordance with applicable federal, state, and local laws.
