Registered Nurse (RN) Utilization Review

Registered Nurse (RN) Utilization Review

At Highpoint Health Sumner we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you're not just valued as an employee, but as a person. As a registered nurse (RN) joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.

Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospital stays.

Essential Functions

• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Calculates the lengths of stay and continued-stay days for patients.
• Maintains a liaison with the Social Service Department to facilitate timely discharge planning.
• Processes claim denials and follow up
• Works closely with Revenue Integrity and Parallon on denied claims.
• Manages UR for observation patients.

Non-Essential Functions performs other duties as assigned

Qualifications and requirements

• Associate's Degree or RN Diploma in Nursing - Accepted with Bachelor's degree in related healthcare field: Bachelor's degree in Nursing or Related Healthcare
• Current RN to practice in the state of TN

Minimum Work Experience Three years' experience in acute care, case management or related healthcare field - Required Two years experience in utilization review - Required. Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Comprehensive medical, dental, and vision plans, plus flexible-spending and health-savings accounts
• Competitive paid time off for full-time employees
• Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
• Tuition reimbursement, loan assistance, and 401(k) matching
• Employee assistance program including mental, physical, and financial wellness
• Professional development and growth opportunities

Highpoint Health Sumner is an Equal Opportunity Employer. Highpoint Health Sumner is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.