What are the responsibilities and job description for the Healthcare Professional - Utilization Review position at Ascension Sacred Heart Emerald Coast?
Job Description
We are seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for reviewing admissions and service requests within assigned units for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria. You will also provide case management and consultation for complex cases, assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals, and assess and coordinate discharge planning needs with healthcare team members.
We are seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for reviewing admissions and service requests within assigned units for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria. You will also provide case management and consultation for complex cases, assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals, and assess and coordinate discharge planning needs with healthcare team members.
