Registered Nurse (RN) Utilization Review

Lifepoint Health • Gallatin, TN

4h • Onsite

About The Position

Your experience matters. At Highpoint Health Sumner, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you’re not just valued as an employee, but as a person. As a registered nurse (RN) joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve. Highpoint Health Sumner is a 167-bed hospital located in Gallatin, TN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone—your experience matters.

Requirements

• Associate’s Degree or RN Diploma in Nursing - Accepted with Bachelor's degree in related healthcare field: Bachelor’s degree in Nursing or Related Healthcare
• Current RN to practice in the state of TN
• Three years’ experience in acute care, case management or related healthcare field - Required
• Two years experience in utilization review - Required.
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Responsibilities

• Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays.
• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Calculates the lengths of stay and continued-stay days for patients.
• Maintains a liaison with the Social Service Department to facilitate timely discharge planning.
• Processes claim denials and follow up.
• Works closely with Revenue Integrity and Parallon on denied claims.
• Manages UR for observation patients.

Benefits

• Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts
• Competitive paid time off for full-time employees
• Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
• Tuition reimbursement, loan assistance, and 401(k) matching
• Employee assistance program including mental, physical, and financial wellness
• Professional development and growth opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree