Utilization Review Nurse

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Tenet Healthcare

WebsiteLinkedInAll Job Openings

10,000+ employees

🧬 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

• Collecting, analyzing, and evaluating clinical documentation received to determine appropriateness of clinical decisions • Adherence to regulatory and departmental timeframes for review of requests received • Responsible for the effective and sufficient support of all utilization management activities to include prospective/ pre-certification review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies. • Using an established set of criteria evaluates, applies and authorizes the medical necessity of inpatient and outpatient services. Referring to medical director when unable to approve a request. • Manages the provision of cost containment services by determining the medical necessity and appropriateness of setting and treatment, and channeling to network providers. • Uses clinical knowledge and evidence based criteria to determine the medical necessity of an inpatient admission, treatment plan and goals, identified gaps, risk for readmission or complications and any barriers to discharge • Collaborates with case / disease management departments and vendors to support client contractual agreements, SLA’s, SPD’s to ensure member receives quality care • Supports quality assurance initiatives, quality indicators and performance standards following standard documentation and ERISA / URAC guidelines

🎯 Requirements

• Bachelor degree in a health related field • Five (5) years of UM/CM experience preferred • Three to five (3-5) years of diverse clinical experience required • RN (Registered Nurse) license required in the state of residence

🏖️ Benefits

• Medical, dental, vision, disability, life, and business travel insurance • Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. • 401k with up to 6% employer match • 10 paid holidays per year • Health savings accounts, healthcare & dependent flexible spending accounts • Employee Assistance program, Employee discount program • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. • For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.