Utilization Nurse (LPN) — Care Access & Denial Support

Community Health Systems; Newport (TN); On-site; USD 42,000 - 64,000; Full time

Job summary

Community Health Systems in Newport, TN is seeking an Utilization Review Nurse - LPN to coordinate admission reviews, status validations, and documentation support within the facility's utilization management program. This role will apply third-party criteria to determine medical necessity and support patient placement decisions.

The position also involves supporting denial and appeal activities, contributing to readmission reduction, quality assurance, and regulatory compliance while protecting

Qualifications

• 2-4 years of hospital or nursing home experience.
• LPN or LVN licensure required.
• Proficient in EHR systems and clinical documentation.

Responsibilities

• Reviews records to determine medical necessity using third-party criteria.
• Validates admission status and identifies discrepancies in patient placement.
• Initiates provider queries to clarify documentation and support utilization.
• Participates in interdisciplinary team meetings to discuss care plans.
• Supports denial and appeal activities and readmission reduction efforts.
• Maintains compliance with policies, payer requirements, and PHI protection.

Education

LPN/LVN licensure

LVN licensure

Job description

Community Health Systems in Newport, TN is seeking an Utilization Review Nurse - LPN to coordinate admission reviews, status validations, and documentation support within the facility's utilization management program. This role will apply third-party criteria to determine medical necessity and support patient placement decisions.

The position also involves supporting denial and appeal activities, contributing to readmission reduction, quality assurance, and regulatory compliance while protecting