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Chart Utilization Review Jobs in Tennessee (NOW HIRING)

Covenant Health

RN CARE MGR II

Sevierville, TN · On-site

Facilitates timely documentation review with the Clinical Documentation Improvement (CDI ... givers and chart findings to ensure patient is meeting daily objectives. * Modifies the case ...

Covenant Health

RN CARE MGR II

Sevierville, TN

Facilitates timely documentation review with the Clinical Documentation Improvement (CDI ... givers and chart findings to ensure patient is meeting daily objectives. * Modifies the case ...

Covenant Health

RN CARE MGR II

Knoxville, TN · On-site

Facilitates timely documentation review with the Clinical Documentation Improvement (CDI ... givers and chart findings to ensure patient is meeting daily objectives. * Modifies the case ...

Covenant Health

RN CARE MGR II

Knoxville, TN · On-site

Facilitates timely documentation review with the Clinical Documentation Improvement (CDI ... givers and chart findings to ensure patient is meeting daily objectives. * Modifies the case ...

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Chart Utilization Review information

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 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 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 September 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, and 4% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

RN CARE MGR II

Sevierville, TN • On-site

Covenant Health
See more jobs at Covenant Healthexternal

Full-time

Re-posted 15 days ago

Job description

Overview
Registered Nurse Care Manager, Continuum of Care
Full Time, 80 Hours Per Pay Period, Day Shift
LeConte Medical Center Overview:
LeConte Medical Center is a part of Covenant Health, our region's top-performing healthcare network and is a 79-bed community hospital located in the heart of Sevier County. We're a full-service, not-for-profit hospital delivering modern medicine and compassionate care to the growing Sevier County community. LeConte offers a full range of health services, including top-tier specialists, a modern ER, and a beautiful Women's Center. Learn more about our amazing facility at https://www.lecontemedicalcenter.com/about-leconte-medical-center/.
Position Summary:
The RN Care Manager II is responsible for integrating evidenced based clinical practice into the patient care setting, coordinating education of staff and patients and serving as a clinical resource and consultant to the health care team. The RN Care Manager II is responsible for promoting patient care coordination and quality through the collaborative development of practice guidelines and clinical pathways that support quality improvement activities. The RN Care Manager II actively seeks opportunities in research designed to identify best practices. The RN Care Manager II has the responsibility, accountability and authority for providing comprehensive care coordination and knowledge to plan, implement, monitor and evaluate the outcomes of care for the designated patient population. The RN Care Manager II is seen as part of the Leadership team on the nursing unit and reports directly to the Manager/Coordinator of Quality and Care Management at the facility level.
Responsibilities
Assessment:
  • Utilizes case finding criteria to screen patients and gather information from the medical record, physician documentation and communication, patient/family as well as other sources to develop a comprehensive plan for the patient that will meet identified needs.
  • Facilitates timely documentation review with the Clinical Documentation Improvement (CDI) specialist, as necessary to ensure appropriate clinical documentation is available in the patient's medical record to guide the care team in determining the expected length of stay.
  • Utilizes the nursing process to evaluate daily through discussion with patient and care givers and chart findings to ensure patient is meeting daily objectives.
  • Modifies the case management plan to meet the changing needs of the patient's clinical condition. Secures needed resources via a multidisciplinary approach to care management strategy to assure timely, efficient and cost effective services.

Collaboration and Planning:
  • Researches, designs and implements practice guidelines and clinical care designs in collaboration with physicians, nursing and other members of the health care team for assigned population.
  • Identifies specific objectives, goals, and actions to meet the patient's identified needs.
  • Collaborates and communicates effectively with the physician and other members of the health care team to plan and implement the care of the patient in a timely manner. Documents results of communication in the patient's medical record.
  • Visits patients in accordance with the plan of care providing education on medications, treatment plan, discharge instructions and modalities as necessary to promote health and continuity of care.
  • Participates in daily multidisciplinary rounds and ensures appropriate disciplines are available

Communication, Implementation, and Coordination of Care:
  • Collaborates directly with the Nurse Manager to ensure the staff adheres to sound clinical practices assisting in the development of educational activities for staff or patients as needed.
  • Works closely with the physician to identify the necessary resources and ensures the appropriate utilization of same.
  • Communicates effectively with physician offices, home health agencies, rehabilitation facilities, long term care facilities, and third party payers to identify goals to assure that patients receive the most appropriate, cost effective and efficient means of care. The RN Care Manager provides documentation in the patient's medical record to communicate the goals and transition plan for the patient.
  • Executes and documents the Care Management activities and interventions related to specific patient goals.
  • Serves as liaison to provide communication with the patient/family, physician and the health care team.
  • Coordinates, organizes, secures, integrates, modifies and documents resources needed to accomplish goals related to the Care Management discharge plan.
  • When necessary, serves as the "brokering" agent to secure coverage for needed community services.

Monitoring:
  • Gathers sufficient information from all relevant sources and documentation regarding the care management plan and activities and or services to enable the Care Manager to determine the plan's effectiveness.
  • Mobilizes resources and coordinates the effort of the health care team to achieve a positive patient transition to appropriate next level of care.
  • Identifies, communicates and initiates actions to mitigate variances in the patient's process of care.
  • Stays abreast of most recent changes in quality related to core measures, Conditions of Participation, Leapfrog and other regulatory bodies to assist in compliance for assigned population.
  • Monitors patient population for potential Healthcare Acquired Conditions, Hospital Acquired Infections and proactively initiates actions to prevent same

Discharge/Transition Planning:
  • When necessary, serves as the "brokering" agent to secure coverage for needed community services.
  • Mobilizes resources and coordinates the effort of the health care team to achieve a positive patient transition to next appropriate level of care.
  • Ensures Multidisciplinary daily rounds at the patient's bedside with care giver and health care team to successfully achieve the desired outcomes and goals.
  • Evaluates the Care Management plan and modifies or changes the plan as needed to meet the patient's needs.

Outcomes/Clinical/Fiscal/Resource Management:
  • Utilizes statistical analysis techniques to measure clinical and fiscal variances from established patient care guidelines, care designs, protocols and core measures.
  • Develops reporting mechanisms to communicate outcomes to physicians and other members of the health care team.
  • Supports cost containment efforts through the recommendation of performance improvement opportunities by the health care team.
  • Maintains ongoing fiscal awareness by communicating outcomes to all stakeholders at specified times
  • Monitors and addresses outcome variances concurrently.
  • Identifies causes of outcome variances and implements actions to improve the variances; evaluates corrective actions for improvement.
  • Proactively seeks the most efficient, cost-effective ways to provide appropriate care.
  • Conducts research to identify "best" practices for achieving patient outcomes.
  • Participates in quality improvement initiatives for assigned population.
  • Addresses end of life issues as they arise with the physician, family and other members of the health care team.
  • Maintains patient Privacy information with other facilities, services and departments involved in Interdisciplinary Discharge Planning Rounds.

General Duties:
  • Serves as patient advocate in performing care management duties.
  • Provides care management services within the scope of practice as a registered nurse meeting all required standards both legal and regulatory.

Education:
  • In collaboration with Nursing and other members of the health care team, researches, plans, develops and assists in patient education; requires return demonstration to ensure patient and family understanding of inpatient plan of care as well as post discharge needs
  • Participates in staff development, orientation, and unit meetings through mentoring, consultation, educational presentations and clinical direction.

Leadership:
  • Actively participates in the hiring, supervision, education, orientation, evaluation and disciplining of staff.
  • Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.

Qualifications
Minimum Education:
Bachelor's degree in Nursing or related field OR certification as listed below.
Minimum Experience:
Four (4) years of experience as a Registered Nurse; a minimum of three (3) years of experience in area of assigned responsibility.
Licensure Requirement:
Current Tennessee RN License. Current certification in Case Management, CCM, ACM or CPHQ OR Bachelors degree in Nursing or related field.

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