Utilization Review RN: Impact & Compliance Leader

CommonSpirit Health; Chattanooga (TN); In loco; USD 75.000 - 110.000; Tempo pieno

Descrizione del lavoro

CommonSpirit Memorial is seeking an Utilization Management Professional to safeguard healthcare efficiency and quality through rigorous clinical decision-making and regulatory compliance. You will review records, authorize services, and prepare physician-review cases with UM teams to align care with established criteria.

This role requires a strong clinical background, deep UM knowledge, and excellent analytical/organizational skills, with emphasis on effective communication, empathy, and

Competenze

• Minimum two years of acute hospital clinical experience or a Masters degree in Case Management or Nursing in lieu of 1 year experience.
• RN license in the state(s) covered is required.
• BLS required within 3 months of hiring.
• Graduate degree in nursing or related healthcare field preferred.
• CCM/ACM-RN or UM certification preferred.

Mansioni

• Review medical records and authorize services.
• Prepare cases for physician review with UM teams.
• Monitor patient care for appropriateness, quality, and cost-effectiveness.
• Apply criteria precisely and communicate findings with stakeholders.

Conoscenze

Acute hospital clinical experience

Formazione

Masters degree in Case Management or Nursing

Descrizione del lavoro

CommonSpirit Memorial is seeking an Utilization Management Professional to safeguard healthcare efficiency and quality through rigorous clinical decision-making and regulatory compliance. You will review records, authorize services, and prepare physician-review cases with UM teams to align care with established criteria.

This role requires a strong clinical background, deep UM knowledge, and excellent analytical/organizational skills, with emphasis on effective communication, empathy, and