Remote Nursing Utilization Review Specialist

Community Health Systems, Inc.; Franklin (TN); A distancia; USD 47.000 - 76.000; A tiempo parcial

Descripción de la vacante

Community Health Systems, Inc. is seeking a PRN Remote Clinical Utilization Review Specialist to evaluate medical necessity and efficiency of hospital services.

You will support denials, appeals, and collaborate with providers to optimize patient care and payer requirements. You will review admissions and continued stays, document results in the EHR, and coordinate with UR coordinators, case managers, and discharge planners in a fast-paced environment.

Formación

• 2-4 years of clinical experience in utilization review, case management, or acute care nursing required.
• LPN licensure or RN licensure required
• CCM or ACM certification preferred

Responsabilidades

• Perform admission and continued stay reviews using evidence-based criteria.
• Collaborate with physicians to obtain documentation for medical necessity and discharge planning.
• Document all utilization review activities in the case management system.

Conocimientos

Utilization management

Interdisciplinary collaboration

HIPAA compliance

EHR proficiency

Educación

Technical School in Practical Nursing

Associate Degree in Nursing

Herramientas

Case management software

Electronic Health Records (EHR)

Descripción del empleo

Community Health Systems, Inc. is seeking a PRN Remote Clinical Utilization Review Specialist to evaluate medical necessity and efficiency of hospital services.

You will support denials, appeals, and collaborate with providers to optimize patient care and payer requirements. You will review admissions and continued stays, document results in the EHR, and coordinate with UR coordinators, case managers, and discharge planners in a fast-paced environment.