RN-Utilization Review

2 weeks ago

Nashville TN United States Ascension Full time
Details
  • Department: Case Management
  • Schedule: Full-Time, Monday-Friday (8:00A - 4:30P)
  • Hospital: Ascension St Thomas
  • Location: Nashville, TN

****TN Nursing License is REQUIRED

Benefits

Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

Responsibilities

Provide health care services regarding admissions, case management, discharge planning and utilization review.

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinates discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Requirements

Licensure / Certification / Registration:

  • Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state
    license for multi-state license recognition "Compact State" obtained prior to hire date or job
    transfer date required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of
    hire.
Additional Preferences

No additional preferences.

Why Join Our Team

Ascension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non profit health system in Middle Tennessee.

Today, the health system offers a highly comprehensive system of care, with more than 250 sites of care that cover a 45-county area in Tennessee consisting of 16 hospitals and a network of affiliated joint ventures, medical practices, clinics and specialty facilities.

Across the state, Ascension Saint Thomas and its partner organizations employ more than 11,000 dedicated associates who care for millions of patients each year.

Ascension Saint Thomas is part of Ascension, one of the nation’s largest faith-based healthcare organizations committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. Ascension includes approximately 134,000 associates, 35,000 affiliated providers and 140 hospitals, serving communities in 19 states and the District of Columbia.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

E-Verify Statement

This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

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