Registered Nurse Utilization Review Full Time Days
Delray Medical Center
Location: Delray Beach, Florida
Internal Number: 2205013836
The Registered Nurse / RN is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patientâ��s resources and right to self-determination. The Registered Nurse / RN has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. The Registered Nurse / RN manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis. The Registered Nurse / RN integrates national standards for case management scope of services including:
Utilization Management services supporting medical necessity and denial prevention
Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient
Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits
The Registered Nurse / RN 's responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c) managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e) timely, complete and concise documentation in the Tenet Case Management documentation system, f) maintenance of accurate patient demographic and insurance information, g) identification and documentation of potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as assigned.
Required qualifications include an active Registered Nurse license with at least two years acute hospital or Behavioral Health patient care experience. BSN preferred (unless required * if Magnet Hospital). Accredited Case Manager (ACM) preferred. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to work in a fast paced environment, critical thinking and problem solving skills and computer literacy.
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Job: Case Management/Home Health
Primary Location: Delray Beach, Florida
Facility: Delray Medical Center
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.