Registered Nurse (RN) Utilization Review

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, 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. How you’ll contribute You’ll 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 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 Department/Unit Summary Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays. Reports to: Director - Case Management 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 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 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. 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. 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.” We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.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.