Registered Nurse Utilization Review

Facility

Ascension Sacred Heart Emerald Coast

Department

Surgery

Schedule

Day | PRN

Retirement: 403(b) plan Well-being support: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources 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.

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

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Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

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