Utilization Management Nurse/LPN

4 weeks ago


Nashville, United States Nashville General Hospital Full time
Description

Nashville General Hospital is hiring a Utilization Management Nurse on a PRN Basis

The Utilization Management Nurse will manage the Prior Authorization process for all ancillary services and procedures to be performed at the Hospital or in Clinics. Coordinate with procedural areas, clinics, physicians, and insurance providers to ensure authorization has been obtained prior to the scheduled test/procedure. The nurse will also verify Authorizations obtained by outside providers and/or institutions. Obtains Retroactive authorizations when needed for changes in test/procedures. Works with contracting to obtain Single Case Agreements when needed. Documents authorizations in conjunction with our claims/billing contractors. Manages In-house authorization process for Obs/IP hospital stays. Reviews Observation cases for conversion to Inpatient. Communicates with hospital teams regarding conversion and authorization. Documents authorizations in conjunction with our claims/billing contractors. Aides in tracking/trending of denials and weekly unbilled claims. *This position will work 4 weekend days a month (4-8 hour shift) with 1 summer and 1 winter holiday required. Potential to work 1-2 shifts a week as well*

As a Utilization Management Nurse, you will:
  • Reviews schedule daily to determine test/procedures/appointments that need Authorization.
  • Contacts Insurance companies to obtain Prior Authorization via phone, fax, or portal.
  • Documents Prior authorization result.
  • Coordinates with ordering office, ordering practitioner, and performing department when additional information is needed for authorization or when authorization is denied.
  • Communicates with outside provider/institution when Authorization is not found to be active or one has not been obtained when needed.
  • Participates in denial & unbilled claims discussion to eliminate barriers and reduce denials
  • Reviews daily census
Required Skills & Qualifications:
  • Graduate of an approved nursing program
  • Active license to practice as a registered nurse in the state of Tennessee
About Nashville General Hospital

Nashville General Hospital (NGH) is Nashville's original community-based hospital. Joint Commission accredited, NGH readily accommodates a wide range of needs from emergency services and acute care to ancillary and ambulatory services. NGH continues to maintain its strong commitment to the healthcare needs of Nashville and Davidson County underserved, while also providing care to all segments of the community

Our benefits include:
  • Metro Health Incentive Program - Access to high quality healthcare without incurring out-of-pocket expenses
  • Flexible Spending Accounts
  • Free Parking for all employees

Nashville General Hospital is an Equal Opportunity Employer/Disability/Veteran

We are an E-Verify employer.

For more information, please click on the following links:
E-Verify Participation Poster: English Spanish
E-Verify Right to Work Poster: English Spanish

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