RN - Utilization Review Specialist - SSO Utilization Review - USA Health Shared Services Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community. 
Responsibilities

Responsibilities 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 Utilization Review 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 Utilization Review audit activities as assigned 
Orients new staff to the Utilizati

RN - Utilization Review Specialist - SSO Utilization Review - USA Health Shared Services

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RN - Utilization Review Specialist - SSO Utilization Review - USA Health Shared Services

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