RN Utilization Review & Care Coordination Specialist

University of South Alabama Health System; Mobile (AL); On-site; USD 65,000 - 90,000; Full time

Job summary

The University of South Alabama Health System in Mobile, AL, seeks a Registered Nurse for Utilization Review to perform reviews, authorizations, and discharge planning to optimize patient care and payer revenue. You will collaborate with physicians and care teams to ensure compliant, efficient care across inpatient settings.

Eligible candidates hold RN licensure in Alabama (or compact state); BSN/MSN preferred; Utilization Review experience is a plus.

Qualifications

• RN licensure in Alabama (or compact state)
• BSN or MSN preferred
• Utilization Review experience preferred

Responsibilities

• Perform quality reviews, prior authorizations, admission/discharge reviews and appeals for denials
• Analyze medical record data to support utilization review
• Collaborate with healthcare team to plan discharge and ensure safe patient flow
• Ensure optimal reimbursement from third-party payors via utilization review activities
• Maintain/communicate with third-party payor representatives and participate in performance improvement
• Document reviews and maintain accurate records in hospital systems

Skills

RN licensure

Interdisciplinary teamwork

Communication with physicians

Education

BSN or MSN preferred

Accredited nursing program

Job description

The University of South Alabama Health System in Mobile, AL, seeks a Registered Nurse for Utilization Review to perform reviews, authorizations, and discharge planning to optimize patient care and payer revenue. You will collaborate with physicians and care teams to ensure compliant, efficient care across inpatient settings.

Eligible candidates hold RN licensure in Alabama (or compact state); BSN/MSN preferred; Utilization Review experience is a plus.