Registered Nurse (RN) - Utilization Review

OverviewJoin our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!At Abrazo Community Health Network, We Understand That Our Greatest Asset Is Our Dedicated Team Of Professionals. That’s Why We Offer More Than a Job – We Provide a Comprehensive Benefit Package That Prioritizes Your Health, Professional Development, And Work-life Balance. The Available Plans And Programs IncludeMedical, dental, vision, and life insurance401(k) retirement savings plan with employer matchGenerous paid time offCareer development and continuing education opportunitiesHealth savings accounts, healthcare & dependent flexible spending accountsEmployee Assistance program, Employee discount programVoluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insuranceNote: Eligibility for benefits may vary by location and is determined by employment statusJob SummaryThe 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.This position integrates national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits May oversee work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central Utilization Authorization CoordinatorResponsibilitiesaccurate 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 and other duties as assigned.QualificationsMinimum RequirementsExperience: Minimum two years acute care experience in UR or other related utilization review experience. Must have working knowledge of InterQual or Milliman guidelinesEducation: Graduate of an accredited school of nursing. Certifications: active Registered Nurse licensePreferred RequirementsEducation: BSNCertifications: Accredited Case Manager (ACM) preferred.DAYS Tuesday thru Sat schedule.Remote but you must live local in AZOrganization DescriptionTenet’s hospital operations segment includes 52 acute care and specialty hospitals in nine states, as well as other facilities such as primary and specialty care clinics, diagnostic imaging centers, micro-hospitals and off-campus emergency departments. Our hospitals are well known for delivering excellent medical care and offering a complete range of services tailored to the needs of each community we serve. From preventative and diagnostic services to expertise in some of the world’s leading technologies, we work with multidisciplinary teams of physicians and healthcare professionals dedicated to the good health and well-being of our neighbors. Tenet also offers opportunities to work at the corporate level in Dallas, TX and in the markets we serve. Corporate and executive positions support the mission of the enterprise.Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.Tenet participates in the E-Verify program. Follow the link below for additional information.E-Verify: http://www.uscis.gov/e-verifyThe employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.2603010119Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship., Work with compensation to get a pay range for this posting,Minimum RequirementsExperience: Minimum two years acute care experience in UR or other related utilization review experience. Must have working knowledge of InterQual or Milliman guidelinesEducation: Graduate of an accredited school of nursing. Certifications: active Registered Nurse licensePreferred RequirementsEducation: BSNCertifications: Accredited Case Manager (ACM) preferred.DAYS Tuesday thru Sat schedule.Remote but you must live local in AZ,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 and other duties as assigned.