RN Utilization Management Lead – Day Shift

Covenant-Health; Knoxville (TN); On-site; USD 90,000 - 130,000; Full time

Job summary

Covenant Health in Knoxville, TN, is seeking a Shift Leader RN Utilization Management to oversee the 24/7 UM program, perform medical necessity reviews, and guide the team through complex cases. The role requires strong leadership, documentation accuracy, collaboration with physicians, payors, and care coordinators, and ensuring timely status notifications and compliant processes.

Full-time position, day shift, 80 hours per pay period, with opportunities to influence care quality and patient

Qualifications

• At least three (3) years of utilization management experience.
• RN license in Tennessee with appropriate clinical certifications.

Responsibilities

• Review precertification requests for medical necessity across payors.
• Maintain records of communications and interventions related to utilization management.
• Communicate clinical and financial data to diverse audiences as needed.
• Collaborate with UM Committee and payor utilization management liaisons.
• Coordinate shift work lists and ensure medical necessity screenings meet timeframes.
• Promote patient advocacy and quality of care, and cost-effective medical outcomes.
• Coordinate notices (denials) of non-coverage and ensure patient liability is correctly managed.
• Stay current on Medicare rules, payor policies, Covenant Health utilization management policies.
• Provide leadership to non-clinical staff and act as liaison between UM Nurse I/II and physician/payor.

Job description

Covenant Health in Knoxville, TN, is seeking a Shift Leader RN Utilization Management to oversee the 24/7 UM program, perform medical necessity reviews, and guide the team through complex cases. The role requires strong leadership, documentation accuracy, collaboration with physicians, payors, and care coordinators, and ensuring timely status notifications and compliant processes.

Full-time position, day shift, 80 hours per pay period, with opportunities to influence care quality and patient