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Chart Utilization Review Jobs in Tennessee (NOW HIRING)

Vertek Staffing

CDI Specialist

Franklin, TN · Remote

$33.50 - $45/hr

The CDI Specialist will work collaboratively with HIM, Coding, Case Management, Utilization Review ... Experience performing concurrent inpatient chart reviews * Experience writing compliant physician ...

Synergy Shared Services

Oasis Reviewer

Nashville, TN · On-site

Review visit utilization for appropriateness of care guidelines and patient condition; report ... other chart audit activities as assigned. * Maintain professional and technical knowledge by ...

Circadia Health

Physician (Tennessee)

Nashville, TN · On-site +1

$200/hr

... chart reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced ...

Circadia Health

Physician (Tennessee)

Nashville, TN · Remote

$200/hr

... chart reviews with the NPs. Your contributions will be instrumental in maintaining high standards of patient care, ensuring regulatory compliance, and optimizing the utilization of our advanced ...

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Chart Utilization Review information

What are the key skills and qualifications needed to thrive as a Chart Utilization Review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is Chart Utilization Review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in Chart Utilization Review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Tennessee? For Chart Utilization Review jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Tennessee look for? The top searched job categories for Chart Utilization Review jobs in Tennessee are:
What cities in Tennessee are hiring for Chart Utilization Review jobs? Cities in Tennessee with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Tennessee as of July 2026, with employment types broken down into 2% As Needed, 82% Full Time, 12% Part Time, 1% Temporary, and 3% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.
Care Management Case Manager

Care Management Case Manager

West Tennessee Healthcare

Jackson, TN • On-site

Full-time

Posted 5 days ago

West Tennessee Healthcare rating

6.3

Company rating: 6.3 out of 10

Based on 80 frontline employees who took The Breakroom Quiz

670th of 890 rated healthcare providers

Job description

Category:
RN Professional
City:
Jackson
State:
Tennessee
Shift:
8 - Day (United States of America)
Job Description Summary:
Care Management Case Managers
Provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with the patients / caregivers and multidisciplinary healthcare team to arrange appropriate post discharge services and optimal transitions in care. Facilitates appropriate LOS, patient satisfaction, and reimbursement for all patients. Develops and maintains collaborative relationships with all members of the healthcare team. Through clinical care coordination drives efficient utilization of resources to reduce length of stay, improve patient flow and throughput, limits variation by applying innovative and evidence based practice, and to reduce the risk of readmission.
ESSENTIAL JOB FUNCTIONS:
  • Obtains or ensures acquisition of appropriate pre-certifications authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party payer guidelines
  • Obtains or facilitates acquisitions of urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements
  • Documents, monitors, intervenes/resolves, and reports clinical denials/appeals and supports retrospective payer audit denials; collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor, and third party payers, etc.
  • Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.; serves as an educational resource to all WTH staff regarding utilization review
  • Assumes roles in assessment physical, psychosocial, & economic needs for transition of care planning to a variety of levels of care; delegates to others as appropriate
  • Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes
  • Interviews and collects patient specified data and chart review related to readmission and appropriately notifies care team
  • Communicates telephonically and electronically with outpatient providers in an effort to enhance the continuum of care
  • Integrates performance improvement principles and customer service excellence principles into all aspects of job responsibilities; practice and governmental commercial payer guidelines
  • Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies
  • Assumes responsibility for WTH required continued education and owns professional growth
  • Performs other duties as assigned or required

JOB SPECIFICATIONS:
EDUCATION:
  • Bachelor of Science in Nursing preferred.
  • Associate or Diploma of Nursing required

LICENSURE, REGISTRATION, CERTIFICATION:
  • Current licensure as Registered Nurse in the state of Tennessee.
  • AHA Basic Cardiac Life Support preferred.
  • ACM, CCM or other certification applicable to Case Management within 3 years of hire preferred

EXPERIENCE:
  • Minimum 3 years of recent acute clinical care experience preferred
  • Preferred experience in care facilitation and management and utilization review

KNOWLEDGE, SKILLS AND ABILITIES:
  • Strong communication skills
  • Ability to develop and maintain positive relationships with customers internal and external to WTH Enterprise
  • Care coordination / discharge and transition planning and community resource knowledge preferred

NONDISCRIMINATION NOTICE STATEMENT
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.

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