Utilization Review Services Registered Nurse

Do you want to join an organization that invests in you as a Utilization Review Services Registered Nurse? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. Benefits: Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Utilization Review Services Registered Nurse like you to be a part of our team. Job Summary and Qualifications: This position will focus on initial and continued to stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education, and Midas worklist rules. Maintain nursing licensure for assigned geographical market and productivity.

Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to the payor Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas Utilize critical thinking skills to review and apply medical necessity criteria Proficient in the application and use of InterQual Analyze documentation of clinical care from the electronic medical record Exhibit determined and assertive verbal and written communication skills when interacting with payors Demonstrate knowledge and effective use of multiple applications, systems, and resources Example, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and Onbase Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies Practice adherence to HCA UR guidelines and practice standards Ability to work independently, show initiative, and work with minimal supervision in a work-from home environment