Registered Nurse Utilization Review Per Diem Days

Summary:

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

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.

Education:

• BSN preferred (unless required * if Magnet Hospital)

Experience:

• Required qualifications include an active Registered Nurse license with at least two years acute hospital or 
  Behavioral Health patient care experience

Certification:

• Accredited Case Manager (ACM) preferred.

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Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.