Registered Nurse (RN) – Utilization Review

The Registered Nurse (RN) will facilitate effective resource coordination to help patients achieve optimal health and access to care. The position involves managing medical necessity process and ensuring timely payment for services.

Requirements

• 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

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

Originally posted on Himalayas