[Hiring] Registered Nurse (RN) - Utilization Review @Tenet Healthcare Corporation

Role Description

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. This position manages the medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. Responsibilities include:

• Integrating national standards for case management scope of services including Utilization Management services supporting medical necessity and denial prevention.
• Coordinating with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient.
• Ensuring compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy.
• Providing education to payers, physicians, hospital/office staff, and ancillary departments related to covered services and administration of benefits.

Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!

Qualifications

• Registered Nurse license.
• Experience in case management or related field preferred.
• Strong communication and negotiation skills.
• Knowledge of medical necessity criteria and payer requirements.

Requirements

• Ability to work collaboratively with healthcare teams.
• Proficiency in managing multiple priorities and deadlines.
• Commitment to continuous professional development.

Benefits

• Medical, dental, vision, and life insurance.
• 401(k) retirement savings plan with employer match.
• Generous paid time off.
• Career development and continuing education opportunities.
• Health savings accounts, healthcare & dependent flexible spending accounts.
• Employee Assistance program, Employee discount program.
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.

Company Description

The Hospitals of Providence have faithfully been serving our community since 1902. Generations of families have chosen our hospitals to be a steward of health in the El Paso community. Our five hospitals include a children's hospital committed to providing the care patients need, when they need it. Today, the Hospitals of Providence are comprised of our region's most trusted hospitals, each dedicated to meeting our families' specific healthcare needs. Join our team!