LPN Utilization Review Nurse
Job Description:
Description Introduction Please note this is an LPN role Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our LPN Utilization Review Nurse opening with our team today and find out what it truly means to be a part of the HCA Healthcare team.Benefits HCA Healthcare 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 wellbeingn401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)nEmployee Stock Purchase Plan with 10% off HCA Healthcare stocknFamily support through fertility and family building benefits with Progyny and adoption assistance.nReferral services for child, elder and pet care, home and auto repair, event planning and morenConsumer discounts through Abenity and Consumer DiscountsnRetirement readiness, rollover assistance services and preferred banking partnershipsnEducation assistance (tuition, student loan, certification support, dependent scholarships)nColleague recognition programnTime Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)nEmployee 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. We are seeking an LPN Utilization Review Nurse for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!Job Summary and Qualifications This position will perform utilization review including authorization procurement, providing clinical to the payor, and performing denial mitigation as needed. This involves a review of the medical record to support admission, level of care provided, 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 Major
Responsibilities: Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to the payorDocument all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in MidasUtilize critical thinking skills to review and apply medical necessity criteriaProficient in the application and use of InterQualAnalyze documentation of clinical care from the electronic medical recordExhibit determined and assertive verbal and written communication skills when interacting with payorsDemonstrate knowledge and effective use of multiple applications, systems, and resourcesExample, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites, and OnbaseCommunicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies will escalate to RN if an order for admission status is neededPractice adherence to HCA UR guidelines and practice standardsAbility to work independently, show initiative, and work with minimal supervision in a work-from-home environmentExcellent personal computer skills (MS Outlook, MS Office, Midas, EMR, OnBase, and other related software).Schedule flexible as per UR department needs, some weekend and or holiday work will be required. Education &
Experience: Vocational nursing degree required3
years of experience in InterQual required5
years of experience in acute hospital experience requiredOr equivalent combination of education and/or experience Licenses, Certifications, & Training: Licensed Practical Nurse - Currently licensed as a licensed practical nurse in the state in which he or she resides and practices, in accordance with law and regulation requiredMulti-state nursing licensure for compact states required HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.n 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.n Across HCA Healthcare's more than 2,000 sites of care, our nurses and colleagues have a positive impact on patients, communities and healthcare. Together, we uplift and elevate our purpose to give people a healthier tomorrow.- Jane Englebright, PhD, RN CENP, FAAN Senior Vice President and Chief Nursing Executive If you find this opportunity compelling, we encourage you to apply for our LPN Utilization Review Nurse opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today! We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.Estimated Salary: $20 to $28 per hour based on qualifications.
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