Remote RN: Inpatient Authorization & Utilization Review

HCA Healthcare, Inc.; Nashville (TN); Remote; USD 70,000 - 100,000; Full time

Job summary

HCA Healthcare, Inc. is seeking a Registered Nurse for a remote utilization review role focused on initial and ongoing authorization and mitigating denials. You will review medical records to determine appropriateness and level of care, while maintaining licensure for your target geographic market.

You will collaborate with payors and physicians, document efforts in Midas, and stay current with InterQual education and related guidelines. Multistate licensure is required for compact states.

Qualifications

• Associates degree in Nursing is required.
• 1+ year of InterQual experience is required.
• Strong nursing background with 2-4 years of nursing experience.
• 1-3 years of case management/utilization review experience is preferred.
• Active RN license in the state of residence and practice.
• Multi-state nursing licensure for compact states is required.

Responsibilities

• Conduct medical record review, validate admission status order, and perform medical necessity reviews for payor communications.
• Document all authorization efforts and payer communications in the Midas system.
• Apply InterQual criteria to determine medical necessity and care level.
• Analyze electronic medical records to assess clinical care documentation.
• Communicate with physicians regarding patient status and documentation for denial mitigation.
• Utilize multiple applications and systems (EHR, payor portals, and collaboration tools) to support workflow.

Skills

InterQual

Nursing

Utilization review

Case management

Payor communications

Education

Associates degree in Nursing

Tools

Electronic Health Records

Payor portals

Right Fax

SharePoint

Onbase

WebEx Teams

Job description

HCA Healthcare, Inc. is seeking a Registered Nurse for a remote utilization review role focused on initial and ongoing authorization and mitigating denials. You will review medical records to determine appropriateness and level of care, while maintaining licensure for your target geographic market.

You will collaborate with payors and physicians, document efforts in Midas, and stay current with InterQual education and related guidelines. Multistate licensure is required for compact states.