Performs utilization management activities for all patients and manages the authorization of services throughout the patient's hospitalization. Communicates clinical detail and criteria to patient insurance carriers. Facilitates billing compliance and serves as a key hospital resource for knowledge of payer reimbursement guidelines. Facilitates control of healthcare resources through ongoing assessment, monitoring and evaluation of patient financial resource utilization.
Associate Degree in Nursing (ADN) from an accredited institution and three (3) years recent nursing experience required. Must be licensed as a Registered Nurse by the Alabama Board of Nursing. BSN or Master’s Degree in health-related field preferred. Must possess American Heart Association BLS certification or obtain within 30 days of hire.