RN Utilization Review Specialist

USA Health

Mobile (AL)

On-site

USD 70,000 - 90,000

Full time

7 days ago

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Job summary

USA Health in Mobile, Alabama is seeking a Registered Nurse for Utilization Review to perform quality reviews, prior authorizations, and discharge planning. You will analyze medical records and collaborate with the healthcare team to ensure safe and timely patient care while securing appropriate reimbursement from third-party payors.

The role requires RN licensure with at least two years of professional nursing experience; Bachelor's or Master's in Nursing is preferred, and Utilization Review

Qualifications

Nursing degree from an accredited school with minimum licensure.
Bachelor's or Master's in Nursing preferred.
Utilization Review experience preferred.
RN licensure required.
Equivalency of education and experience possible.

Responsibilities

Perform quality reviews, prior authorizations, and discharge reviews.
Analyze medical records to support utilization functions.
Collaborate with care teams to formulate safe discharge plans.
Ensure optimal reimbursement from third party payors.
Communicate with providers via phone, in person, and email.
Maintain accurate records in the Hospital Information System.
Participate in Performance Improvement activities.

Skills

Utilization Review

Medical record analysis

Interdisciplinary collaboration

Documentation accuracy

Communication skills

Education

RN licensure

Bachelor's in Nursing

Master's in Nursing

Tools

Hospital Information System

Job description

The role requires RN licensure with at least two years of professional nursing experience; Bachelor's or Master's in Nursing is preferred, and Utilization Review

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