Abrazo Region Centralized RN Utilization Review - Local Remote

Why Abrazo�
When you join Abrazo�s Community Built On Care, you will find a diverse team of dedicated nurses who work together with one goal: to provide quality, compassionate care in the communities we serve. You will have the opportunity to create meaningful connections and work alongside team members who are passionate about improving our patients� lives. Here, we value employee growth and work hard to cultivate a nurturing work environment where you can develop your skills as a nursing professional. If this sounds like a great place to work, you�re right! We think so too, and we invite you to join us.

Job Summary of the Utilization Review Registered Nurse Full Time Days
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 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 Coordinator

The individual�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. This position is Sunday through Thursday. It is a remote position after 6 weeks of training at our Regional office. Onsite will be required once a month. Experienced RN in Utilization Review required.

In return for your talents we offer a host of exceptional benefits:
RN Professional Clinical Ladder with 3 levels and corresponding financial rewards.
Specialty Certification Differential
Flexible Work Schedules
Tuition Assistance of up to $5,250.00
401(K) with company match and Employee Stock Purchase Program
Competitive Market Hourly Rates
Night and Weekend Differential pay
Excellent Medical and Dental Benefits

#LI-CB4

Minimum Qualifications:
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.

Requirements:
Must 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.

Employment practices will not be influenced or affected by an applicant�s or employee�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.