RN Utilization Management Shift Lead — Day Shift

Covenant Health; Knoxville (TN); On-site; USD 85,000 - 110,000; Full time

Job summary

Covenant Health in Knoxville, TN seeks a Shift Leader RN Utilization Management to oversee 24/7 utilization management operations on the day shift, supervise staff, and coordinate with physicians and payors to determine medical necessity and appropriate patient status.

The role requires RN licensure in Tennessee, a minimum of three years in utilization management, and proven leadership with strong communication and documentation skills; collaboration across departments ensures accurate status

Qualifications

• At least three years of utilization management experience.
• RN licensure in the State of Tennessee.
• Professional certifications such as CCM or CPHQ preferred.
• Supervisory experience preferred.

Responsibilities

• Review precertification requests for medical necessity.
• Maintain records of communications and interventions.
• Collaborate with UM Committee and payor liaisons.
• Coordinate notices of non-coverage and ensure accurate patient liability.
• Lead and motivate shift team and ensure compliance with policies.

Skills

RN licensure

Leadership

Utilization management

Communication skills

Interdisciplinary collaboration

Documentation accuracy

Tools

Utilization management database

Job description

Covenant Health in Knoxville, TN seeks a Shift Leader RN Utilization Management to oversee 24/7 utilization management operations on the day shift, supervise staff, and coordinate with physicians and payors to determine medical necessity and appropriate patient status.

The role requires RN licensure in Tennessee, a minimum of three years in utilization management, and proven leadership with strong communication and documentation skills; collaboration across departments ensures accurate status