Acute Care Utilization Review Case Manager (RN)

Southeast Health; Alabama; On-site; USD 70,000 - 90,000; Full time

Job summary

Southeast Health is seeking a Utilization Review Case Manager (RN) to oversee admissions and continued stay reviews in the acute care setting. This role requires strong collaboration with medical staff, timely precertifications, and effective handling of Medicare/Medicaid notifications and denials.

Ideal candidates hold an RN license in Alabama with a track record in discharge planning, utilization review, and clinical leadership.

Qualifications

• Associates degree in Nursing required.
• Active Alabama RN license required.
• Bachelor’s degree in Nursing preferred.

Responsibilities

• Performs admissions and continued stay reviews of inpatients and observation patients.
• Performs precertification on procedures ordered during hospitalization.
• Issues Medicare/Medicaid notifications of medical necessity changes to patients.
• Issues non-coverage letters to patients if needed during stay.
• Documents billing notes in the EMR payer communications navigator to avoid denials.
• Performs medical necessity denial appeals.
• Maintains collaboration with the medical staff to promote continuity of care.

Skills

Nursing knowledge

Discharge planning

Team collaboration

Leadership

Analytical skills

Education

Associates degree in Nursing

Registered Nurse license in Alabama

Bachelor’s degree in Nursing (preferred)

Tools

EMR systems

Job description

Southeast Health is seeking a Utilization Review Case Manager (RN) to oversee admissions and continued stay reviews in the acute care setting. This role requires strong collaboration with medical staff, timely precertifications, and effective handling of Medicare/Medicaid notifications and denials.

Ideal candidates hold an RN license in Alabama with a track record in discharge planning, utilization review, and clinical leadership.