RN Utilization Review Specialist

University of South Alabama Health System; Mobile, Northern (AL, KY); Hybrid; USD 70,000 - 90,000; Full time

Job summary

University of South Alabama Health System seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior authorizations, and discharge planning. The role collaborates with physicians and care teams to ensure compliant, timely patient care and optimal reimbursement from third-party payors.

The position requires an Alabama RN license, with a Bachelor's degree in Nursing preferred and Utilization Review experience preferred.

Qualifications

• Graduation from an accredited school of nursing.
• Bachelor's or Master's degree in nursing preferred.
• Utilization Review experience preferred.
• RN state licensure required.
• Comparable combination of education and experience may substitute for the above requirements.

Responsibilities

• Perform utilization reviews, including prior authorizations and discharge reviews.
• Analyze medical records to support appropriate level of care and reimbursement.
• Collaborate with healthcare team to formulate discharge plans and ensure timely patient flow.
• Communicate with third-party payors and providers by phone, in person, and email.
• Maintain accurate records and participate in hospital and department education.

Skills

Nursing

Interdisciplinary collaboration

Documentation

Communication

Education

Bachelor's in Nursing

Master's in Nursing (preferred)

RN licensure (state)

Tools

Hospital Information System

Job description

University of South Alabama Health System seeks an experienced Registered Nurse for Utilization Review to perform quality reviews, prior authorizations, and discharge planning. The role collaborates with physicians and care teams to ensure compliant, timely patient care and optimal reimbursement from third-party payors.

The position requires an Alabama RN license, with a Bachelor's degree in Nursing preferred and Utilization Review experience preferred.