Registered Nurse (RN) - Utilization Review
Conifer Health Solutions•Rock Hill, SC
About The Position
The Registered Nurse (RN) - Utilization Review facilitates effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, while balancing patient resources and the right to self-determination. The role is responsible for ensuring care is provided at the appropriate level based on medical necessity. It manages the medical necessity process to support accurate and timely payment for services, which may involve negotiating with a payer on a case-by-case basis.
Requirements
- Associate degree in Nursing.
- Active Registered Nurse license.
- At least two years of acute hospital or Behavioral Health patient care experience.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
Responsibilities
- Balance clinical and financial requirements and resources while advocating for patient needs and managing resources judiciously.
- Ensure the patient is in the appropriate status and level of care based on medical necessity, and submit cases for secondary physician review according to Tenet policy.
- Provide education to physicians and the healthcare team on effective care progression, appropriate levels of care, and safe and timely patient transitions.
- Ensure compliance with federal, state, and local regulations and accreditation requirements affecting the case management scope of services.
- Perform related duties as assigned.
Benefits
- Sign-on bonus of up to $20,000, based on eligibility.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
