Registered Nurse (RN) - Utilization Review
About the role
Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance.
Responsibilities
- Responsible for providing accurate medical necessity screening and submission for Physician Advisor review.
- Securing and documenting authorization for services from payers.
- Managing concurrent disputes.
- Collaborating with payers, physicians, office staff, and ancillary departments.
- Timely, complete, and concise documentation in the Tenet Case Management documentation system.
- Maintenance of accurate patient demographic and insurance information.
- Identification and documentation of potentially avoidable days.
- Identification and reporting over and underutilization.
Qualifications
Education: Required: Graduate of an accredited school of nursing. Preferred: Academic degree in nursing (bachelor's or master's). Experience: Required: 2 years of acute hospital or behavioral health patient care experience with at least 1 year utilization review in an acute hospital or commercial/managed care payer setting. Certifications: Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered. Preferred: Accredited Case Manager (ACM).
Benefits
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
Note: Eligibility for benefits may vary by location and is determined by employment status.