RN Utilization Review Specialist - Impactful Care

USA Health Systems

Mobile (AL)

On-site

USD 62,000 - 78,000

Full time

9 days ago

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Benefits offered by this job

Benefits eligibility for 20+ hours per

Professional growth opportunities

Job summary

USA Health Systems in Mobile, AL seeks an experienced Registered Nurse for Utilization Review. You will perform reviews, admissions and discharge evaluations, and coordinate with physicians to optimize patient care and reimbursement.

The role requires Alabama RN licensure and 2 years of nursing experience; Utilization Review experience is preferred. This on-site position offers benefits for 20+ hours per week and opportunities for professional growth.

Qualifications

Graduation from an accredited school of nursing and Alabama RN licensure.
2 years of professional nursing experience required.
Utilization Review experience preferred.
RN – Registered Nurse – State licensure and/or Compact licensure required.

Responsibilities

Functions independently per policy and payor requirements, including reviews, authorizations, and case management for DRG payors.
Analyze medical record data to complete Utilization Review processes.
Collaborate with healthcare team to formulate discharge plans and ensure timely inpatient flow.
Ensure optimal reimbursement by applying Utilization Review procedures.
Communicate with physicians and healthcare providers via phone, in person, and email.
Participate in interdisciplinary patient care meetings and hospital committees.