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Abrazo Health: Rn Utilization Review Ft Days Remote

Abrazo Health

This is a Full-time position in Houston, TX posted March 7, 2022.

REMOTE Position ( Must live locally in AZ)Utilization Review expr required.Helping people feel better isn’t just about the treatment we give – 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, you’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 SummaryThe 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 patient’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: Utilization Management services supporting medical necessity and denial prevention Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits May oversee work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central Utilization Authorization CoordinatorThe Individual’s Responsibilities Include The Following Activities accurate medical necessity screening and submission for Physician Advisor review, securing and documenting authorization for services from payers, managing concurrent disputes, collaborating with payers, physicians, office staff and ancillary departments, timely, complete and concise documentation in the Tenet Case Management documentation system, maintenance of accurate patient demographic and insurance information, identification and documentation of potentially avoidable days, identification and reporting over and underutilization, 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.

6 weeks of training at our Region Office.

Onsite will be required once a month.

Experienced RN in Utilization Review required.

Remote position.

6 weeks training in OfficeQualificationsTHE RN UTILIZATION REVIEW FULL TIME DAYS CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.Minimum QualificationsRequired qualifications include an active Registered Nurse license.

BSN PreferredMinimum two years acute care experience in UR or other related utilization review experience.Accredited Case Manager (ACM) preferred.RequirementsMust complete Tenet’s InterQual® 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 HealthPrimary Location: Phoenix, ArizonaFacility: Abrazo RegionJob Type: Full-timeShift Type: Days

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