Utilization Review Services Registered Nurse

HCA Healthcare; Nashville (TN); Remote; USD 65,000 - 80,000; Full time

Job summary

Join a leading healthcare organization as a Utilization Review Services Registered Nurse. This role focuses on initial and ongoing utilization review, assessing medical records, and ensuring appropriate patient care. Enjoy comprehensive benefits and a supportive work environment.

Benefits

Medical Coverage

401(k) with 100% Match

Employee Stock Purchase Plan

Educational Support

Colleague Recognition Programs

Qualifications

• 1+ year experience with InterQual required.
• Current RN license in the practicing state.

Responsibilities

• Review medical records and validate admission status.
• Document authorization efforts and payor communications.
• Analyze clinical documentation from electronic records.

Skills

Critical Thinking

Effective Communication

Education

Associate Degree in Nursing

Tools

InterQual

EHRs

Midas

Job description

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Description

Introduction

Do you want to join an organization that invests in you as a Utilization Review Services Registered Nurse? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our team members over three years.

Benefits

Parallon offers a comprehensive rewards package supporting health, life, career, and retirement, including:

• Medical coverage with many services at no cost or low copay, including prescriptions, behavioral health, telemedicine, and AirMed transportation.
• Additional options for dental, vision, life, disability, flexible spending, supplemental health plans, auto and home insurance, identity theft protection, legal counseling, long-term care, moving assistance, pet insurance, and more.
• Free counseling services for emotional, physical, and financial wellbeing.
• 401(k) with a 100% match on 3%-9% of pay.
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock.
• Family support benefits, including fertility, family building, and adoption assistance.
• Referral services for child, elder, and pet care, home and auto repair, event planning, etc.
• Discounts through Abenity and other providers.
• Retirement planning, rollover assistance, and banking partnerships.
• Educational support, including tuition, student loans, certifications, and scholarships.
• Colleague recognition programs.
• Time Away From Work programs, including paid time off, family leave, disability coverage, and leaves of absence.
• Employee Health Assistance Fund providing free coverage based on income.

Learn more about Employee Benefits. Eligibility may vary by location.

Every role impacts patient lives, and we seek a dedicated Utilization Review Services Registered Nurse to join our team.

Job Summary and Qualifications

This role focuses on initial and ongoing utilization review for authorization procurement and mitigation of concurrent denials. Responsibilities include assessing medical records for appropriateness and level of care, treatment modalities, medications, services, and applying treatment protocols. Maintain current standards such as annual InterQual education and Midas training. Maintain nursing licensure and productivity.

What you will do:

• Review medical records, validate admission status, conduct medical necessity reviews, and communicate with payors.
• Document authorization efforts and payor communications in Midas.
• Apply critical thinking to review and determine medical necessity.
• Proficient in InterQual application and use.
• Analyze clinical documentation from electronic records.
• Communicate effectively with payors and physicians regarding patient status and denials.
• Utilize multiple systems and resources, including EHRs, payor portals, and communication tools.
• Work independently with minimal supervision in a remote environment.

Qualifications:

• Associate degree in Nursing required.
• 1+ year experience with InterQual required.
• 2-4 years of nursing experience preferred.
• 1-3 years of case management or utilization review preferred.
• Current RN license in the practicing state; multi-state licensure for compact states required.

Parallon provides revenue cycle management services for HCA Healthcare, serving nearly 1,000 hospitals and 3,000 practices. We are recognized for ethical practices and charitable contributions. Join our team of 270,000 professionals to make a difference.

We are an equal opportunity employer and do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability.