Registered Nurse – Utilization Review

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🕒 5 days ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Tenet Healthcare

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

👥 B2C

💰 $2G Post IPO debt on 2022-07

Healthcare • B2C

Tenet Healthcare is a for-profit healthcare services company that owns and/or operates hospitals and hospital programs through subsidiaries and affiliates across the United States. The company's website and materials describe acute-care hospitals, emergency centers, specialty services (including cancer centers and advanced cardiac imaging), medical office buildings, physician careers and community health networks; Tenet emphasizes compliance, community service, and clinical innovation.

📋 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