Registered Nurse (RN) Utilization Review
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Job Location:
Gallatin, TN - USA
Monthly Salary:
Not Disclosed
Posted on:
6 hours ago
Vacancies:
1 Vacancy
Job Summary
Registered Nurse (RN) Utilization Review
Job Type: Full Time 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 youre not just valued as an employee but as a person. As aregistered nurse (RN)joining our team youre embracing a vital mission dedicated tomaking 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.
How youll contribute
Youll make an impact by utilizing your specialized plan-of-care intervention and serving as a patient-care innovator. You will shape exceptional patient journeys every day and leverage your skills and our cutting-edge technology to directly impact patient wellbeing.
What we offer
Fundamental to providing great care is supporting and rewarding our 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
Department/Unit Summary
Monitors adherence to the hospitals utilization review plan to ensure appropriate use of hospital services hospital admissions and extended hospitals stays.
Reports to: Director - Case Management
Qualifications and requirements:
Associates degree or RN Diploma in Nursing - Accepted with bachelors degree in related healthcare field: Bachelors degree in nursing or Related Healthcare Field - Required
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 Skills
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. 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 patients 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.
About our Health System
Highpoint Health Sumner is a 167-bed hospital located in Gallatin TN and is part ofLifepoint Health a diversified healthcare delivery network committed tomaking communities healthierwith acute care rehabilitation and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters.
EEOC Statement
Highpoint Health Sumneris an Equal Opportunity Health Sumneris committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
Required Experience:
IC
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Hospice Care
- Workers' Compensation Law
- Home Care
- Nursing
- Catheterization
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
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 a ... View more
