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Recently postedRemoteHealthcare

Registered Nurse Utilization Review

AscensionPensacola🇺🇸United States

Quick overview

SeniorityMid Senior
Work modeRemote
LocationPensacola, United States
Case ManagementComplianceNursing

Job description

  • Location: Pensacola, FL

  • Facility: Ascension Sacred Heart Emerald Coast

  • Department: Surgery

  • 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.
Licensure / Certification / Registration
  • 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.
Education
  • Diploma from an accredited school/college of nursing required. OR Required professional licensure at time of hire.

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