Job Summary
A for-profit health care organization that owns and operates hospitals and surgery centers throughout the US is filling a position for a Telecommute Utilization Review Services Registered Nurse in Nashville.
Core Responsibilities Include:
- Conducting medical record review, validating admission status order, conducting a medical necessity review and providing clinical information to payor
- Documenting all efforts to gain authorization and payor communications, confirming all days authorized or denied and documenting in internal systems
- Communicating with physicians regarding patient status, clinical documentation and concurrent denial mitigation strategies
Applicants must meet the following qualifications:
- Bachelor’s degree in Nursing is preferred
- 1 year experience in InterQual
- Demonstrated strong clinical background with 2-4 years nursing experience
- 1-3 years relevant case management/utilization review experience is preferred
- RN license
- Ability to analyze documentation of clinical care from the electronic medical record