RN Utilization Review-Crestwood Medical Center-FT-1st shift
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Huntsville Hospital Health System
Huntsville, AL, US
Summary
The RN will analyze medical necessity and acute care appropriateness for hospital admissions and continued stays. They will also ensure proper authorization from payers and maintain documentation to minimize the risk of post-discharge denials.
Job Description
Overview
Utilization management is the analysis of the medical necessity, acute care appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required, and that documentation supports the care delivered in such a way that minimizes the risk of denials after discharge.
Qualifications
Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse
Preferred Education: Bachelors Science Nursing or higher
Required Experience: 2 years previous nursing experience
Preferred Experience: Utilization Review or Case Management experience
Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse
Preferred License/Registration/Certification: ACM or CCM Certification
Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, Microsoft Suite and email applications.
Huntsville Hospital is an 881-bed hospital that serves as the regional referral center for North Alabama and southern Tennessee. Huntsville Hospital is governed by the Health Care Authority of the City of Huntsville and is the second-largest hospital in Alabama. In recent years, the hospital has expanded its services throughout the region with the development of Huntsville Hospital Health System, which includes hospitals in Huntsville, Madison, Athens, Decatur, Boaz, Guntersville, Moulton, Red Bay, Sheffield, Scottsboro, and Fayetteville, Tenn. The Health System includes more than 2,300 patient beds and 21,000 employees.
Founded
1895
Company size
10,001+ employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Huntsville, AL
Huntsville Hospital is an 881-bed hospital that serves as the regional referral center for North Alabama and southern Tennessee. Huntsville Hospital is governed by the Health Care Authority of the City of Huntsville and is the second-largest hospital in Alabama. In recent years, the hospital has expanded its services throughout the region with the development of Huntsville Hospital Health System, which includes hospitals in Huntsville, Madison, Athens, Decatur, Boaz, Guntersville, Moulton, Red Bay, Sheffield, Scottsboro, and Fayetteville, Tenn. The Health System includes more than 2,300 patient beds and 21,000 employees.
Founded
1895
Company size
10,001+ employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Huntsville, AL
