RN Utilization Management I: Care Coordination & Compliance

Covenant-Health; Knoxville (TN); On-site; USD 75,000 - 95,000; Full time

Job summary

Covenant Health seeks an experienced Registered Nurse for Utilization Management in Knoxville, TN. The role supports a 24/7 utilization management program and coordinates documentation, communication, and collaboration with physicians, payors, and care teams.

Responsibilities include reviewing precertification requests, maintaining records, and participating in audits and committee activities to ensure appropriate admission status and optimal patient outcomes.

Qualifications

• Three (3) years of acute care nursing experience; a minimum of two (2) years of experience in area of assigned responsibility. Prefer recent utilization management or case management experience.
• Current licensure as a Registered Nurse (RN) in Tennessee; CCM/CPHQ certification preferred or equivalent expertise in Utilization Management.

Responsibilities

• Reviews precertification requests for medical necessity for all payors as applicable, referring to the second level physician reviewer those that require additional expertise.
• Maintains accurate records of all communications and interventions related to utilization management.
• Exhibits effective verbal and written communication skills in order to clearly present clinical and financial data to various audiences as necessary.
• Collaborates with UM Committee when applicable.
• Collaborates with payor utilization management liaisons and medical directors as applicable.
• Establishes effective rapport with other employees, professional support service staff, payors, patients, families and physicians.
• Intervenes in Peer-to-Peer meetings between physicians and payors as applicable.
• Performs other duties as assigned.

Job description

Covenant Health seeks an experienced Registered Nurse for Utilization Management in Knoxville, TN. The role supports a 24/7 utilization management program and coordinates documentation, communication, and collaboration with physicians, payors, and care teams.

Responsibilities include reviewing precertification requests, maintaining records, and participating in audits and committee activities to ensure appropriate admission status and optimal patient outcomes.