RN Inpatient Authorization

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

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 benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs 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 support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for 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.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

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.