Remote RN: Inpatient Authorization & Utilization Review

HCA Healthcare; Nashville (TN); Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Healthcare benefits

Wellbeing support

PTO & disability

401(k) with match

Education support

Fertility and family benefits

Life insurance

Job summary

HCA Healthcare is seeking a Registered Nurse for a work-from-home utilization review role. You will assess medical records for appropriateness and level of care, focusing on initial and continued authorization and mitigation of denials, across the assigned geographic market and within 60 miles of an HCA hospital.

This position requires an Associate Degree in Nursing, RN licensure, InterQual experience, and 1+ year in case management.

Qualifications

• Associates degree in Nursing required.
• 1+ year of experience with InterQual.
• Strong nursing background with 2–4 years of nursing experience.
• Current RN license; multi-state licensure preferred.

Responsibilities

• Conduct medical record review and assess medical necessity.
• Document authorization efforts and payor communications in Midas.
• Interact with physicians regarding patient status and documentation.
• Apply InterQual guidelines to care decisions.
• Utilize multiple applications and systems for payor communications.
• Maintain nursing licensure in the designated market.

Skills

InterQual

Nursing Experience

Communication Skills

Education

Associate degree in Nursing

RN License (US state)

Tools

Midas

EMR / EHR

Payor portals

SharePoint

Job description

HCA Healthcare is seeking a Registered Nurse for a work-from-home utilization review role. You will assess medical records for appropriateness and level of care, focusing on initial and continued authorization and mitigation of denials, across the assigned geographic market and within 60 miles of an HCA hospital.

This position requires an Associate Degree in Nursing, RN licensure, InterQual experience, and 1+ year in case management.