RN Utilization Management I - Care Optimization & UM Lead

Covenant Health; Knoxville (TN); On-site; USD 70,000 - 95,000; Full time

Job summary

Covenant Health in Knoxville, TN seeks an RN for Utilization Management to perform 24/7 medical necessity reviews, document interventions, and coordinate with UM team and payors. The role emphasizes patient advocacy and interdisciplinary collaboration.

Qualified applicants have minimum acute care nursing experience and Tennessee RN licensure; CCM/CPHQ is preferred. Join a team dedicated to high-quality, cost-effective care delivery at Covenant Health.

Qualifications

• Three (3) years of acute care nursing experience.
• Two (2) years in area of assigned responsibility.
• RN licensure in Tennessee; CCM/CPHQ preferred.

Responsibilities

• Reviews precertification requests for medical necessity.
• Maintains records of communications and interventions.
• Collaborates with UM Committee and payor liaisons as applicable.
• Communicates with hospital and payor medical directors.
• Performs daily utilization management tasks and reports.
• Promotes patient advocacy and cost-effective outcomes.
• Provides guidance to non-clinical staff.

Skills

Acute care nursing

Utilization management

Communication skills

Job description

Covenant Health in Knoxville, TN seeks an RN for Utilization Management to perform 24/7 medical necessity reviews, document interventions, and coordinate with UM team and payors. The role emphasizes patient advocacy and interdisciplinary collaboration.

Qualified applicants have minimum acute care nursing experience and Tennessee RN licensure; CCM/CPHQ is preferred. Join a team dedicated to high-quality, cost-effective care delivery at Covenant Health.