TRA Utilization Review - Texas RN license

Tenet Healthcare; Town of Texas (WI); Remote; USD 70,000 - 95,000; Full time

Job summary

An innovative healthcare provider seeks a Remote Registered Nurse for a contract role in Utilization Review. This position requires a minimum of two years of acute care experience and proficiency in Cerner, AllScripts, and Interqual systems. The selected candidate will be responsible for facilitating care, ensuring compliance with regulatory standards, and promoting patient satisfaction through effective resource coordination. Join a forward-thinking team dedicated to transforming community healthcare and making a significant impact from day one. This role offers the opportunity to work remotely while contributing to essential healthcare services.

Qualifications

• Minimum 2 years of Acute Care Utilization Review experience required.
• Proficiency in Cerner, AllScripts, and Interqual systems necessary.

Responsibilities

• Facilitating care through effective resource coordination.
• Supporting medical necessity and denial prevention.
• Providing education to physicians and caregivers.

Skills

Acute Care Utilization Review

Cerner

AllScripts

Interqual

BLS Certification

Education

Active Texas RN License

Residency in Texas or other specified states

Job description

Job Title: Remote Registered Nurse (RN) Utilization Review Contract Position

Be among the first 25 applicants, 3 weeks ago.

Work Hours: 10 am CST to 6 pm CST, Monday - Friday.

Position Overview: This RN Utilization Review contract requires a minimum of 2 years of Acute Care Utilization Review experience. Case Manager or Social Work experience alone will not suffice. Candidates must have robust UR experience specifically in an Acute Care Hospital setting, with proficiency in Cerner, AllScripts, and Interqual systems. UR experience with insurance companies does not qualify.

Requirements:

• Active Texas RN license or Texas Compact RN license.
• Residency in Texas, Florida, Arizona, Tennessee, Massachusetts, or Michigan, with a valid driver’s license or tax filing address.
• Must have BLS certification.
• Up-to-date Titer and immunization records.
• At least two years of direct UR experience in an acute hospital environment, not on the insurance side.

Additional Details:

• This is a contract role; no job training provided, only orientation to our systems.
• Must be prepared to 'hit the ground running' and demonstrate your acute care UR knowledge from day one.

Responsibilities include:

1. Facilitating care along the continuum through effective resource coordination.
2. Supporting medical necessity and denial prevention in utilization management.
3. Promoting appropriate length of stay, readmission prevention, and patient satisfaction through transition management.
4. Ensuring care is delivered in the right sequence and at the appropriate level.
5. Maintaining compliance with regulatory standards, TJC accreditation, and hospital policies.
6. Providing education to physicians, patients, families, and caregivers.

Position Details:

• Seniority level: Associate
• Employment type: Contract
• Job function: Healthcare Provider
• Industry: Hospitals and Healthcare

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