Registered Nurse (RN) - Utilization Review

Up to $20,000 Sign-on Bonus Based on Eligibility

The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis.

Responsibilities

• Utilization Management- Balances clinical and financial requirements and resources in advocating for patient needs with judicious resource management
• Payer Authorization - Assures the patient is in the appropriate status and level of care based on Medical Necessity and submits case for Secondary Physician review per Tenet policy
• Education - Ensures and provides education to physicians and the healthcare team relevant to the effective progression of care, appropriate level of care, and safe and timely patient transition
• Compliance - Ensures compliance with federal, state, and local regulations and accreditation requirement impacting case management scope of services
• Performs related duties as assigned

Qualifications

Required

• Education: Associates in Nursing required. Experience: 
• Certification:  Required qualifications include an active Registered Nurse license with at least two years acute hospital or Behavioral Health patient care experience

Preferred

• Education: BSN preferred