Registered Nurse (RN) Utilization Review

Registered Nurse (RN)Utilization Review Job Type: FT | Days Your experience matters. 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 are not just valued as an employee, but as a person. As a registered nurse (RN) joining our team, you’ll embrace 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. About our Health System Highpoint Health Sumner is a 167‑bed hospital located in Gallatin, TN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone your experience matters. How you'll contribute Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospital stays. Reports to: Director – Case Management. FLSA: Non‑Exempt. Essential Functions Establishes and maintains efficient methods ensuring the medical necessity and appropriateness of hospital admissions. Performs concurrent reviews for patients to ensure extended stays are medically justified and documented in patient records. Calculates lengths of stay and continued‑stay days for patients. Maintains liaison with the Social Service Department to facilitate timely discharge planning. Processes claim denials and follows 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) – or Bachelor’s degree in Nursing or related healthcare field. Current RN license to practice in the state of Tennessee. 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, ability to work with minimal supervision, and to perform in a stressful environment and take appropriate action. Why Join Highpoint Health Sumner Comprehensive medical, dental, and vision plans, plus flexible‑spending and health‑savings accounts. Competitive paid time off for full‑time employees. Income‑protection programs including 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 covering mental, physical, and financial wellness. Professional development and growth opportunities. EEOC Statement 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. Lifepoint Health is a leader in community‑based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post‑acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country. #J-18808-Ljbffr Highpoint Health - Sumner with Ascension Saint Thomas