Description

Introduction

Do you want to join an organization that invests in you as a Utilization Review Services Registered Nurse? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
  
  

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Utilization Review Services Registered Nurse like you to be a part of our team.

Job Summary And Qualifications

This position will focus on initial and continued to stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education, and Midas worklist rules. Maintain nursing licensure for assigned geographical market and productivity.

What you will do in this role:

• Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to the payor
• Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas
• Utilize critical thinking skills to review and apply medical necessity criteria
• Proficient in the application and use of InterQual
• Analyze documentation of clinical care from the electronic medical record
• Exhibit determined and assertive verbal and written communication skills when interacting with payors
• Demonstrate knowledge and effective use of multiple applications, systems, and resources
• Example, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and On base
• Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies
• Practice adherence to HCA UR guidelines and practice standards
• Ability to work independently, show initiative, and work with minimal supervision in a work-from home environment
  
  

What qualifications you will need:

• Associates degree in Nursing required
• 1+ year(s) of experience in InterQual required
• Strong clinical background with 2-4 years of nursing experience required
• 1 – 3 years of relevant case management/utilization review experience preferred
• Registered Nurse - Currently licensed as a registered professional nurse in the state in which he or she resides and practices, in accordance with law and regulation required Multi-state nursing licensure for compact states required
  
  

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Good people beget good people."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Utilization Review Services Registered Nurse opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.