RN-Utilization Review
Company: Ascension Health
Location: Jacksonville
Posted on: January 26, 2023
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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)
Keywords: Ascension Health, Jacksonville , RN-Utilization Review, Healthcare , Jacksonville, Florida
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