RN: Utilization Management & Care Coordination

Tenet Healthcare; Rock Hill (SC); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Sign-on bonus up to $20,000

Job summary

Tenet Healthcare is seeking a registered nurse to coordinate resources for patients, ensuring care at the appropriate level based on medical necessity. This role focuses on balancing patient needs with payer requirements and hospital policies to promote timely and efficient treatment.

You will lead utilization management, pursue payer authorization when needed, educate the care team on care progression and transitions, and maintain compliance with federal, state, and accreditation standards.

Qualifications

• Active RN license with at least two years of acute hospital or Behavioral Health experience
• Associate degree in Nursing required
• BSN preferred

Responsibilities

• Facilitate resource coordination to support patient access and appropriate utilization of resources
• Manage medical necessity process to ensure timely payment and negotiate with payers as needed
• Balance clinical and financial requirements in utilization management
• Educate physicians and healthcare teams on progression of care and patient transitions
• Ensure compliance with federal, state, and accreditation requirements
• Perform related duties as assigned

Skills

Resource coordination

Case management

Payer negotiation

Education delivery

Education

Associate in Nursing

BSN

Job description

Tenet Healthcare is seeking a registered nurse to coordinate resources for patients, ensuring care at the appropriate level based on medical necessity. This role focuses on balancing patient needs with payer requirements and hospital policies to promote timely and efficient treatment.

You will lead utilization management, pursue payer authorization when needed, educate the care team on care progression and transitions, and maintain compliance with federal, state, and accreditation standards.