RN Utilization Management Specialist

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

Job summary

Covenant Health in Knoxville, TN is seeking a Registered Nurse for Utilization Management, day shift. The RN UM I will perform utilization reviews, coordinate with physicians, and support insurance processes to ensure appropriate patient status and timely care.

Candidates should have at least 3 years of acute care nursing and 2 years in UM or case management; current Tennessee RN license is required; CCM/CPHQ certification is preferred.

Qualifications

• Three years of acute care nursing experience.
• Minimum two years in area of assigned responsibility (UM/CM).
• CCM/CPHQ certification preferred or equivalent expertise.

Responsibilities

• Reviews precertification requests for medical necessity and refers complex cases to physician reviewer.
• Maintains accurate records of communications and interventions related to utilization management.
• Communicates clinical and financial data clearly to diverse audiences; collaborates with UM team and payors.
• Coordinates with payor utilization management liaisons and medical directors.
• Assists with audits and education, ensuring compliance with Covenant Health policies.

Skills

Nursing

Utilization management

Case management

Education

RN licensure

Job description

Covenant Health in Knoxville, TN is seeking a Registered Nurse for Utilization Management, day shift. The RN UM I will perform utilization reviews, coordinate with physicians, and support insurance processes to ensure appropriate patient status and timely care.

Candidates should have at least 3 years of acute care nursing and 2 years in UM or case management; current Tennessee RN license is required; CCM/CPHQ certification is preferred.