RN Utilization review

Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary: Provides health care services regarding admissions case management discharge planning andutilization : Reviews admissions and service requests within assigned unit for prospective concurrent andretrospective medical necessity and/or compliance with reimbursement policy criteria. Provides casemanagement and/or consultation for complex cases. Assists departmental staff with issues related to coding medical records/documentation precertification reimbursement and claim denials/appeals. Assesses and coordinates discharge planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and of Work: Within scope of job requires critical thinking skills decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.

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