Registered Nurse Utilization Review
Pensacola, Florida
You'll review admissions and service requests for medical necessity and reimbursement compliance, and handle complex case management.
- Shift and hours
- Days Schedule: Day | PRN
- Unit and setting
- Surgery department Department: Surgery
- License
- RN license Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date or job transfer date.Florida RN license before hire
- Term
- Per Diem Schedule: Day | PRNPRN
Do you qualify?
- License
- Florida RN license before hire Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date or job transfer date. Check your license
- License
- Multi-state RN license from a Compact State, held before hire Credentialed from State Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date. Check your license
- Education
- Diploma from an accredited school/college of nursing, or required professional licensure at time of hire
The role and schedule
- Day to day
- complex case management and consultation Provides case management and/or consultation for complex cases.
- Day to day
- claim denial and appeal support Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Day to day
- discharge planning with the care team Assesses and coordinates discharge planning needs with healthcare team members.
- Day to day
- utilization review and statistical reports May prepare statistical analysis and utilization review reports as necessary.
- Day to day
- payer utilization rules compliance oversight Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.
The workplace
Ask Mira
Your fit
Questions to ask
- Can you walk me through base pay range and differentials?
- What should I expect for weekly hours, weekend, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
On your path
Case Management is a specialty you move into. Bedside years first. That experience is what gets you in.
Original listing
Posted on Ascension’s careers page.
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- Facility
- Ascension Sacred Heart Emerald Coast
- Department
- Surgery
- Schedule
- Day | PRN
Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management 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 regulations.
Licensure / Certification / Registration Required Credential(s): Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date or job transfer date. Licensed as a Registered Nurse in Florida. Credentialed from State Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date.
Education Diploma from an accredited school/college of nursing required. OR Required professional licensure at time of hire.
What's around it?
Pensacola, FLFrom Census ACS 2024.
Living costs about 2% below the US average
- Median rent
- $1,322/mo
- Household income
- $74,212/yr, all local households, not nurse pay