Helping people feel better isnâ��t just about the treatment we give â�� the relationships we create and the compassion we share are just as important. Abrazo hospitals make a difference in the lives of our communities and the lives of those we work alongside every day. We know it takes a special person to work in healthcare, and we are committed to providing our people with an enriching and rewarding environment.
From your first day, youâ��ll be part of a group of some of the most talented nursing professionals united in a common goal to care for those in our community. Ready to work with awe-inspiring teammates who are dedicated to making a difference? Join us in going above and beyond.
RN Utilization Review Full Time Days Position Summary
The individual in this position 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 individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis.
This position integrates national standards for case management scope of services including:
Â· Utilization Management services supporting medical necessity and denial prevention
Â· Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient
Â· Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
Â· Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits
Â· May oversee work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central Utilization Authorization Coordinator
The individualâ��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.
Special Skills: 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.
Must know InterQual Critieria
6 weeks of training at our Region Office. Onsite will be required once a month. Experienced RN in Utilization Review required.
THE RN UTILIZATION REVIEW FULL TIME DAYS CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.
Required qualifications include an active Registered Nurse license. BSN Preferred
Minimum two years acute care experience in UR or other related utilization review experience.
Accredited Case Manager (ACM) preferred.
Interqual Knowledge required
Must complete Tenetâ��s InterQualÂ® education course within 30 days of hire (and at least annually thereafter) and pass with a score of 85 or better.
Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire.
Job: Case Management/Home Health
Primary Location: Phoenix, Arizona
Facility: Abrazo Region
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.