RN-Utilization Review

Company: Ascension Health
Location: Jacksonville
Posted on: January 26, 2023

Job Description:

Details

+ Department: Utilization Management

+ Schedule: Monday-Friday 8:00am-4:30pm

+ Hospital: Ascension St. Vincent's Riverside

+ Location: Jacksonville, Florida

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Connect with your Talent Advisor today for additional specifics.

Responsibilities

Provide health care services regarding admissions, case management, discharge planning and utilization review.

+ Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.

+ Provide case management and/or consultation for complex cases.

+ Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.

+ Assess and coordinate discharge planning needs with healthcare team members.

+ May prepare statistical analysis and utilization review reports as necessary.

+ Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

Requirements

Licensure / Certification / Registration:

+ Licensed Registered Nurse obtained prior to hire date or job transfer date. Licensed as a RegisteredNurse in Florida. Credentialed from State Board of Nursing or current home state license formulti-state license recognition "Compact State" obtained prior to hire date or job transfer date required.

Education:

+ Diploma from an accredited school/college of nursing OR Required professional licensure at time ofhire required.

Additional Preferences

No additional preferences.

Why Join Our Team

Ascension St. Vincent's is expanding in the fastest-growing county in Northeast Florida with the addition of a fourth regional hospital, Ascension St. Vincent's St. Johns County. Serving Northeast Florida and Southeast Georgia, Ascension St. Vincent's has been providing caregivers in every discipline a rewarding career in healthcare since 1873.

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information regarding your EEO rights, view the EEO is the Law (https://www.eeoc.gov/poster) poster.

Pay Non-Discrimination Notice (https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp\_%20English\_formattedESQA508c.pdf)

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.E-Verify (https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify\_Participation\_Poster\_ES.pdf)

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