Strategic RN Utilization Review Specialist

University of South Alabama Health System; Mobile (AL); On-site; USD 60,000 - 80,000; Full time

Job summary

USA Health in Mobile, AL seeks a Registered Nurse to perform Utilization Review functions and collaborate with the care team to ensure quality, compliance, and efficient discharge planning.

The role requires Alabama RN licensure, a nursing degree, and preferred Utilization Review experience; duties include reviewing records, communicating with physicians and payors, and maintaining documentation in the Hospital Information System.

Qualifications

• Must be a graduate from an accredited nursing program with Alabama licensure.
• RN licensure required; compact state licensure acceptable.
• Utilization Review experience preferred; 2 years professional nursing experience recommended.

Responsibilities

• Performs Utilization Review reviews and related duties for DRG payors.
• Analyzes medical records and collaborates with the care team on discharge planning.
• Ensures optimal reimbursement by applying Utilization Review processes and communicating with payors.
• Maintains documentation in the Hospital Information System and with physicians.

Education

Graduation from an accredited school of nursing meeting the minimum standards set by the State of Alabama and 2 years or professional nursing experience Required

Bachelor's Degree or Master's Degree in nursing Preferred

Utilization Review experience Preferred

RN - Registered Nurse - State Licensure and/or Compact State Licensure Required

Comparable combination of education and experience may substitute for the above requirements

Job description

USA Health in Mobile, AL seeks a Registered Nurse to perform Utilization Review functions and collaborate with the care team to ensure quality, compliance, and efficient discharge planning.

The role requires Alabama RN licensure, a nursing degree, and preferred Utilization Review experience; duties include reviewing records, communicating with physicians and payors, and maintaining documentation in the Hospital Information System.