Registered Nurse (RN) Utilization Review

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    "ExternalDescriptionStr": "<p><span><strong>Registered Nurse (RN)&nbsp;Utilization Review&nbsp;</strong></span><br><span>Job Type: FT | Days&nbsp;</span></p><p>&nbsp;</p><p class=\"\"><span><strong>Your experience matters</strong></span></p><p class=\"\"><span>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&nbsp;<strong>registered nurse (RN)</strong>&nbsp;joining our team, you’re embracing a vital mission dedicated to&nbsp;</span><i><span>making communities healthier</span></i><span>. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.</span></p><p class=\"\"><span><strong>About our Health System</strong></span><br><span>Highpoint Health Sumner is a 167-bed hospital located in Gallatin, TN and is part of&nbsp;</span><a target=\"_blank\" rel=\"nofollow\">Lifepoint Health</a><span>, a diversified healthcare delivery network committed to&nbsp;</span><i><span>making communities healthier</span></i><span>®&nbsp;with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone—your experience matters</span></p><p class=\"\"><span><strong>How you’ll contribute</strong></span></p><p class=\"\">Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays.<br>Reports to: Director - Case Management FLSA: Non-Exempt<br><br><strong>Essential Functions</strong></p><ul><li><p class=\"\">Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.</p></li><li><p class=\"\">Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.</p></li><li><p class=\"\">Calculates the lengths of stay and continued-stay days for patients.</p></li><li><p class=\"\">Maintains a liaison with the Social Service Department to facilitate timely discharge planning.</p></li><li><p class=\"\">Processes claim denials and follow up</p></li><li><p class=\"\">Works closely with Revenue Integrity and Parallon on denied claims.</p></li><li><p class=\"\">Manages UR for observation patients.</p></li><li><p class=\"\">Non-Essential Functions performs other duties as assigned</p></li></ul><p class=\"\"><span><strong>Qualifications and requirements</strong></span></p><ul><li><p class=\"\"><span>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</span></p></li><li><p class=\"\">Current RN to practice in the state of TN</p></li></ul><p class=\"\"><strong>Minimum Work Experience</strong><br>Three years’ experience in acute care, case management or related healthcare field - Required<br>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.</p><p class=\"\"><span><strong>Why Join Highpoint Health Sumner</strong></span></p><p class=\"\"><span>Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:&nbsp;&nbsp;</span></p><ul><li><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><span class=\"\">Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts&nbsp;&nbsp;</span></li><li><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><span class=\"\">Competitive paid time off for full-time employees&nbsp;</span></li><li><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><span class=\"\">Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage&nbsp;</span></li><li><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><span class=\"\">Tuition reimbursement, loan assistance, and 401(k) matching&nbsp;&nbsp;</span></li><li><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><span class=\"\">Employee assistance program including mental, physical, and financial wellness&nbsp;</span></li><li><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><span class=\"\">Professional development and growth opportunities</span></li></ul><p class=\"\">&nbsp;</p><p class=\"\"><span><strong>EEOC Statement</strong></span></p><p class=\"\"><span>Highpoint Health Sumner&nbsp;is an Equal Opportunity Employer.&nbsp;Highpoint Health Sumner&nbsp;is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.\"</span></p>",
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