RN Utilization Review Specialist

101 Southeast Health; United States; On-site; USD 70,000 - 90,000; Full time

Job summary

Southeast Health in Alabama is seeking an experienced Utilization Review Nurse to screen medical records for medical necessity on admission and during acute care stays. You will collaborate with the medical staff and payer communications to promote appropriate resource use, patient satisfaction, and efficient care delivery.

Requires an Alabama RN license with an Associates degree (Bachelor's preferred); 2 years acute care and UR experience recommended.

Qualifications

• Associates degree in Nursing and current RN license in Alabama.
• Bachelor’s degree or higher preferred.
• Two years acute care experience; three years UR preferred.

Responsibilities

• Screens inpatient and outpatient records for medical necessity during admission and stay.
• Performs precertification on procedures; communicates changes to patients.
• Issues non-coverage letters when applicable and documents billing notes.
• Maintains collaboration with medical staff to ensure timely care.
• Participates in multidisciplinary teams and supports discharge planning.

Skills

Clinical decision making

Team leadership

Discharge planning

Adaptability in fast-paced environment

Education

Associates degree in Nursing

Bachelor’s degree or higher in Nursing

Tools

EMR systems

Report generation

Job description

Southeast Health in Alabama is seeking an experienced Utilization Review Nurse to screen medical records for medical necessity on admission and during acute care stays. You will collaborate with the medical staff and payer communications to promote appropriate resource use, patient satisfaction, and efficient care delivery.

Requires an Alabama RN license with an Associates degree (Bachelor's preferred); 2 years acute care and UR experience recommended.