Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective 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 regulations.Complexity 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.
VivPost
RN - Utilization review in austin at Unknown Company
- Typical pay
- $71,760–$113,550
For context, most registered nurses earn between $71,760–$113,550 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.
This position is listed as full time and able to be worked remotely.