Registered Nurse (RN) - Utilization Review
About The Position
The Registered Nurse in Utilization Review facilitates effective resource coordination to help patients achieve optimal health, access to care, and appropriate use of resources, while considering patients’ resources and right to self-determination. The role is responsible for ensuring care is provided at the appropriate level based on medical necessity and managing the medical necessity process to support accurate, timely payment for services. This may include negotiating with a payer on a case-by-case basis. The position is with Piedmont Medical Network - Rock Hill Hospital. The organization describes a supportive work environment focused on professional growth and work-life balance.
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 patients are in the appropriate status and level of care based on medical necessity, and submit cases for secondary physician review according to Tenet policy.
- Provide and ensure education for physicians and the healthcare team on effective progression of care, appropriate level of care, and safe, timely patient transitions.
- Ensure compliance with federal, state, and local regulations and accreditation requirements affecting case management services.
- Perform related duties as assigned.
Benefits
- Medical, dental, vision, and life insurance.
- 401(k) retirement savings plan with employer match.
- Paid time off.
- Career development and continuing education opportunities.
- Health savings accounts and healthcare and dependent flexible spending accounts.
- Voluntary benefits including pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, and auto and home insurance.
- Sign-on bonus of up to $20,000, based on eligibility.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
