Utilization Review RN Case Manager – Acute Care

Southeast Health; Dothan (AL); On-site; USD 65,000 - 85,000; Full time

Job summary

Southeast Health seeks an Utilization Review Nurse to screen medical records for medical necessity on admission and during hospital stay. You will conduct admissions and continued stay reviews for inpatients and observation patients, handle precertifications, and issue notifications for medical necessity changes and non-coverage letters.

Collaboration with medical staff is essential for timely care. Ideal candidates hold an RN license in Alabama with acute care experience and a background in

Qualifications

• Associates degree in Nursing
• Current RN license in the State of Alabama
• Bachelor’s degree or higher in Nursing (preferred)
• Two (2) years acute care experience (required)
• Three (3) years acute care experience (preferred)
• One (1) year utilization review experience (preferred)
• Maintain licensure and demonstrate ongoing professional development
• Ability to generate reports and use computer systems for documentation

Responsibilities

• Screens medical records for medical necessity upon admission and during stay
• Performs admissions and continued stay reviews for inpatients and observation patients
• Performs precertification on procedures
• Notifies patients of medical necessity changes and non-coverage letters
• Documents payer communications in EMR to avoid denials
• Maintains collaboration with medical staff to promote continuity of care
• Participates in education and may attend required meetings/webinars

Skills

Discharge planning

Multidisciplinary teamwork

Problem solving

Leadership

Clinical judgment

Adaptability

Fast-paced environment

Communication

Education

Associate's degree in Nursing

Bachelor’s degree in Nursing

Job description

Southeast Health seeks an Utilization Review Nurse to screen medical records for medical necessity on admission and during hospital stay. You will conduct admissions and continued stay reviews for inpatients and observation patients, handle precertifications, and issue notifications for medical necessity changes and non-coverage letters.

Collaboration with medical staff is essential for timely care. Ideal candidates hold an RN license in Alabama with acute care experience and a background in