TriStar Centennial Medical Center - Nashville, TN Utilization Review Nurse--PRN
Our 657 bed hospital is both nationally and locally recognized, including being named as one of the nation's Top 100 Hospitals in the areas of cardiology, stroke, orthopedics and breast cancer management. As a result of the continued advances in quality care, many improvements in all areas of healthcare have been made and thousands of lives have been significantly impacted. This position will play a key part in continuing our success!
The Utilization Review Nurse performs medical necessity reviews on all commercial payor admissions to obtain authorization for care from insurance payor. Completes InterQual reviews on all patients. Documents all information related to insurance reimbursement in appropriate systems. Centennial Medical Center
is currently looking for a Utilization Review Nurse. Responsibilities:
- Communicate with impact.
- Provide clear and accurate information to insurance representatives, MD offices and Case Managers.
- Promote and maintain collaborative working relationships.
- Complete medical review and interpretation of medical record to obtain authorization of care and services.
- Maintain good intradepartmental and community relationships.
- Behave in ethical and honest manner to foster trust; accept responsibility for own actions.
- Support the facility's Standards of Performance and ICARE values.
- Current TN RN licensure required or Master's prepared social worker, counselor, etc. for appropriate psychiatric clinical setting.
- Three (3) years of related clinical experience.
- Demonstrated skill in problem solving, critical thinking and negotiation.
- Demonstrated skill in fostering positive interpersonal relationships.
- Working knowledge of reimbursement issues (e.g. managed care, UR, etc.) preferred.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom