Utilization Review Services RN PRN

HCA Healthcare; Nashville (TN); Remote; USD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking healthcare provider as a Utilization Review Services RN PRN. In this dynamic role, you'll engage in critical patient assessments, ensuring high standards of care and compliance with healthcare guidelines. You'll leverage your nursing expertise to conduct thorough reviews, communicate effectively with healthcare professionals, and utilize advanced systems to enhance patient outcomes. This position offers a supportive environment with comprehensive benefits, including medical coverage, retirement plans, and educational assistance. If you're passionate about making a difference in patient care, this opportunity is perfect for you.

Benefits

Medical Coverage

Dental Insurance

401(k) Plan

Employee Stock Purchase Plan

Educational Assistance

Paid Time Off

Flexible Spending Accounts

Adoption Assistance

Legal Counseling

Pet Insurance

Qualifications

• 1+ years experience with InterQual and nursing.
• 2-4 years nursing experience required.

Responsibilities

• Review medical records and validate admission orders.
• Communicate with payors and document authorization efforts.
• Analyze clinical documentation from electronic health records.

Skills

InterQual

Critical Thinking

Nursing

Case Management

Education

RN License

Nursing Degree

Tools

Midas

WebEx Teams

SharePoint

Onbase

Job description

Search by title, specialty, keyword, MOS, or job number.

Search by city, state, or zip code.

business_center Case Management find_in_page Job ID: 3314988

Do you have the PRN career opportunities as a Utilization Review Services RN PRN you want with your current employer? We have an exciting opportunity for you to join Parallon, part of HCA Healthcare, the nation's leading healthcare provider.

Parallon offers a comprehensive total rewards package supporting your health, life, career, and retirement. Our plans and programs include:

• Medical coverage with many services at no cost or low copay, including prescription drugs, behavioral health, telemedicine, and free AirMed transportation.
• Additional benefits such as dental, vision, life, disability, flexible spending accounts, supplemental health plans, auto and home insurance, identity theft protection, legal counseling, long-term care, moving assistance, pet insurance, and more.
• Fertility and family building benefits through Progyny.
• Free counseling and resources for emotional, physical, and financial wellbeing.
• Family support including adoption assistance, child and elder care resources, and discounts.
• 401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
• Employee Stock Purchase Plan.
• Retirement services and banking partnerships.
• Educational assistance for tuition, student loans, certifications, and scholarships.
• Colleague recognition programs.
• Time Away From Work programs, including paid time off, family leave, and disability coverage.

Note: Benefits eligibility may vary by location.

Our teams are dedicated, caring colleagues. If you are passionate about creating positive patient interactions, this role might be your next opportunity. We value your knowledge and expertise!

Job Summary and Qualifications

This role involves initial and ongoing utilization review for authorization and denial mitigation, assessing medical records for appropriateness and care levels, and staying current with HCA education standards such as InterQual and Midas. Maintaining nursing licensure and productivity in the assigned geographical area is required.

Responsibilities include:

• Review medical records, validate admission orders, conduct medical necessity reviews, and communicate with payors.
• Document authorization efforts and payor communications in Midas.
• Apply medical necessity criteria using critical thinking skills and proficiency in InterQual.
• Analyze clinical documentation from electronic health records.
• Communicate effectively with physicians regarding patient status and documentation.
• Use multiple systems and resources, such as WebEx Teams, Payor portals, SharePoint, and Onbase.
• Adhere to HCA UR guidelines and standards.
• Work independently with minimal supervision in a remote environment.

Qualifications required:

• At least 1 year of experience with InterQual.
• 2-4 years of nursing experience.
• 1-3 years of case management or utilization review experience preferred.
• Current RN license in the practicing state, including multi-state licensure for compact states.