Inight Global is looking to bring on a new Utilization Review RN to their team in the Mobile, AL area. This individual performs functions independently, according to policy and third party payor requirements, to include: quality reviews, prior authorizations, initial/admission reviews, continued stay reviews, discharge reviews, retrospective reviews, appeals as appropriate for denials, and case management reviews for DRG payors; analyzes medical record data to complete functions; collaborates with members of the healthcare team, patients, families, and managed care workers to formulate appropriate discharge plans and promote a safe and timely flow through inpatient setting; ensures optimal reimbursement from third party payors through appropriate implementation of Care Management functions; communicates with healthcare providers via telephone, in person, and email (i.e., discussion with physicians regarding plan of care, length of stay, and stay type); establishes and maintains a professional relationship with third party payor representatives; participates in interdisciplinary patient care meetings as assigned; utilizes a PC to access the Hospital Information System; enhances professional growth and development through participation in educational programs; completes annual education on nationally recognized level of care criteria; participates in all Care Management audit activities as assigned; orients new staff to the Care Management process as assigned; reports quality of care concerns discovered during Care Management functions to the Director; facilitates timely patient throughput through discharge planning commensurate with the care needs of the patient; evaluates chart documentation for completeness relative to current ICD requirements and communicates deficiencies; demonstrates proficiency in Early Periodic Screening Diagnosis and Treatment (EPSDT) by performing independently, according to regulatory requirements, the following functions as assigned: identification of patient eligibility, collection of data required to perform screening, performance of Inter-periodic Screening Components, and communication of screening findings to all related parties; maintains accurate and complete records both written and via personal computer; documents reviews according to hospital policy; completes/documents forms/requests from third party payors and regulatory parties; documents variances, discharge plans and EPSDT functions; utilizes proper body mechanics when moving equipment that is necessary to perform essential functions; communicates and uses appropriate customer relation skills with physicians, patients, families and healthcare team in person and via telephone; adheres to current Infection Control and Safety Standards; responds to overhead pages; accesses and accurately maintains electronic and paper medical records; participates on committees as assigned; participates in Performance Improvement activities as assigned; regular and prompt attendance; ability to work schedule as defined and additional hours and call as needed.

Requirements:

• Bachelor’s degree in nursing
• three years professional nursing experience
• licensure with the state of Alabama as a registered nurse
• Previous utilization review experience
• Proof of vaccination

Job Types: Full-time, Contract

Pay: $30.00 - $36.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Mobile, AL: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Required)

Experience:

• Registered Nurse: 3 years (Required)
• Utilization review: 1 year (Required)

License/Certification:

• Alabama RN (Required)

Work Location: One location

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