Tennessee Licensed Utilization Management Specialist

Job Summary

To support optimal patient care, the full-time Tennessee Licensed Utilization Management Specialist will facilitate accurate certification and documentation for reimbursement, conduct initial admissions based on medical necessity criteria, and collaborate with multidisciplinary teams in a remote work environment.

Key Responsibilities

• Facilitates optimal reimbursement through certification and denial processes
• Ensures appropriate admission status and patient throughput in urgent or emergent situations
• Collaborates with multidisciplinary team members to maintain appropriate levels of care

Required Qualifications

• Current Tennessee Registered Nurse licensure
• Bachelor's degree in a relevant field
• Minimum of 1 year of relevant work experience
• Expertise in utilization review and clinical applications systems
• Familiarity with InterQual Level of Care Criteria and Milliman Care Guidelines