Registered Nurse, Revenue Integrity & Utilization Management
Full Time, 80 Hours Per Pay Period, Day Shift
Covenant Health Overview:
Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.
Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.
Position Summary:
The RN Utilization Management I will perform utilization management functions to include medical necessity reviews to promote a utilization management program that operates 24 hours a day 7 days a week. Exhibits extraordinary leadership and professionalism in role. Prepares and reviews necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status placement. Collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires clarification. Utilizes electronic utilization management database for documentation of interventions and communications so as to ensure accurate reporting. Collaborates with patient account services, physicians, care coordinators, physician advisors and facility departments as related to utilization management. Communicates with hospital and payor medical directors in order to correctly determine the medical necessity of patient status with a patient advocacy focus.
Recruiter: Matt Clingon || mclingon@covhlth.com || 931-459-7253
Minimum Education :
None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
Minimum Experience:
Three (3) years of acute care nursing experience; a minimum of two (2) years of experience in area of assigned responsibility. Prefer recent utilization management or case management experience.
Licensure Requirements:
Current licensure as a Registered Nurse (RN) as issued by the State of Tennessee. CCM/CPHQ certification preferred or equivalent expertise in area of Utilization Management as evidenced by performance. Perfers the following: RN with strong knowledge of surgical procedures and terminology. CPT coding knowledge is also highly desirable. The ideal candidate must be highly organized, able to efficiently prioritize and multitask. The candidate should possess excellent verbal and digital communication skills and exhibit proficient computer navigation including proficient use of MS word, excel and Adobe Acrobat.
RN License
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