RN Inpatient Authorization

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

This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

Job Summary and Qualifications

This position will focus on initial and continued to stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education, and Midas worklist rules. Maintain nursing licensure for assigned geographical market and productivity.

What you will do in this role:

• Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to the payor
• Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas
• Utilize critical thinking skills to review and apply medical necessity criteria Proficient in the application and use of InterQual
• Analyze documentation of clinical care from the electronic medical record
• Exhibit determined and assertive verbal and written communication skills when interacting with payors
• Demonstrate knowledge and effective use of multiple applications, systems, and resources
• Example, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and Onbase
• Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies

What qualifications you will need:

• Associates degree in Nursing required
• 1+ year(s) of experience in InterQual required
• Strong clinical background with 2-4 years of nursing experience required
• 1-3 years of relevant case management/utilization review experience preferred
• Registered Nurse - Currently licensed as a registered professional nurse in the state in which he or she resides and practices, in accordance with law and regulation required
• Multi-state nursing licensure for compact states required

Benefits

PDU Other, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefitsfor medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support,including free counseling and referral services
• Time away from workprograms for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education supportthrough tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefitsfor fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.