Registered Nurse – Utilization Review

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🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Tenet Healthcare

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🧬 Biotechnology

🧘 Wellness

💰 $2G Post-IPO Debt on 2022-05

Healthcare • Biotechnology • Wellness

Tenet Healthcare is a leading healthcare services company that owns and operates hospitals, outpatient centers, and other healthcare facilities. With a focus on providing high-quality and accessible medical care to communities across the United States, Tenet Healthcare is committed to improving patient outcomes and enhancing the healthcare experience. They also offer innovative treatment options and invest in health technology to support their mission of delivering exceptional care.

📋 Description

• Provide accurate medical necessity screening and submit cases for Physician Advisor review • Secure and document authorization for services from payers • Manage concurrent disputes • Collaborate with payers, physicians, office staff, and ancillary departments • Maintain timely, complete, and concise documentation in the Tenet Case Management documentation system • Maintain accurate patient demographic and insurance information • Identify and document potentially avoidable days • Identify and report overutilization and underutilization • Facilitate resource coordination to support optimal health, access to care, and appropriate resource utilization • Ensure care is provided at the appropriate level based on medical necessity • Negotiate with payers on a case-by-case basis when needed • Coordinate with payers to authorize appropriate level of care and medically necessary length of stay • Support compliance with regulatory requirements, accreditation standards, and Tenet policy • Educate payers, physicians, hospital and office staff, and ancillary departments on covered services and benefit administration

🎯 Requirements

• Graduate of an accredited school of nursing • 2 years of acute hospital or behavioral health patient care experience • At least 1 year of utilization review experience in an acute hospital or commercial/managed care payer setting • Current RN license, certification, or registration required by law or regulation in the state of practice or policy • Active RN license for the state(s) covered • Academic degree in nursing (bachelor's or master's) preferred • Accredited Case Manager (ACM) preferred

🏖️ 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 and dependent flexible spending accounts • Employee Assistance program • Employee discount program • Pet insurance • Legal insurance • Accident and critical illness insurance • Long term care • Elder and childcare benefits • Auto and home insurance • Supportive work environment fostering professional growth and work-life balance