RN-Utilization Review

Þtails Department:Utilization Review Schedule:FT day shift Hospital:Ascension Sacred Heart Panama City Location: Panama City, Florida After onsite orientation and proficiency in position has been attained, there will be the option for the position to be remote. Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance and salary range at the time of the offer. Responsibilities 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. Requirements Licensure / Certification / Registration: Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date or job transfer date required. Licensed as a Registered Nurse in Florida required. Credentialed from State Board of Nursing or current home state license for multi-state license recognition