Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Registered Nurse (RN) Case Manager Director
Pulaski, TN · On-site
$70 - $90/hr
Two years recent related clinical experience preferred in Utilization Review, Quality Improvement, and Case Management. * Licenses: Must have a current Tennessee or compact state RN license.
Registered Nurse (RN) Case Manager Director
Pulaski, TN · On-site
$70 - $90/hr
Two years recent related clinical experience preferred in Utilization Review, Quality Improvement, and Case Management. * Licenses: Must have a current Tennessee or compact state RN license.
The RN Case Manager works in collaboration with patients, providers, and key stakeholders in ... utilization review documents according to hospital policy and state/ federal regulations.
The RN Case Manager works in collaboration with patients, providers, and key stakeholders in ... utilization review documents according to hospital policy and state/ federal regulations.
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Quick apply
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
Review various reports and identify trends to assist in financial forecasting. * Responsibility for ... Current Licensure or permit to practice as a Registered Nurse in the State of Tennessee or compact ...
UTILIZATION MANAGMENT (UM) COORDINATOR - PRN
Franklin, TN · On-site
$60 - $80/hr
The UM Coordinator reviews cases for appropriateness of admission, continued stay, and discharge ... Must possess a current RN license or Master's Degree in Behavioral Health field (e.g. Counseling ...
UTILIZATION MANAGMENT (UM) COORDINATOR - PRN
Franklin, TN · On-site
$60 - $80/hr
The UM Coordinator reviews cases for appropriateness of admission, continued stay, and discharge ... Must possess a current RN license or Master's Degree in Behavioral Health field (e.g. Counseling ...
Experience in Quality, Case Management, Utilization Review, or similar field is preferred. Licenses and Certifications: Valid and active RN licensure in appropriate state BLS Required Work ...
Experience in Quality, Case Management, Utilization Review, or similar field is preferred. Licenses and Certifications: Valid and active RN licensure in appropriate state BLS Required Work ...
Clinical Review Nurse I - Medicare Part B
$67K - $100K/yr
Clinical Review Nurse I - Medicare Part B Clinical Review Nurse I - Medicare Part B Location: This ... Current unrestricted RN license required. * This position is part of our Wellpoint Federal division ...
New
Clinical Review Nurse I - Medicare Part B
$67K - $100K/yr
Clinical Review Nurse I - Medicare Part B Clinical Review Nurse I - Medicare Part B Location: This ... Current unrestricted RN license required. * This position is part of our Wellpoint Federal division ...
New
Full-time - UR Coordinator
Memphis, TN · On-site
Valid TN RN license, LCSW, or LPC preferred. Knowledge: Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills ...
Full-time - UR Coordinator
Memphis, TN · On-site
Valid TN RN license, LCSW, or LPC preferred. Knowledge: Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills ...
Full-time - UR Coordinator
Memphis, TN · On-site
Valid TN RN license, LCSW, or LPC preferred. Knowledge: Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills ...
Full-time - UR Coordinator
Memphis, TN · On-site
Valid TN RN license, LCSW, or LPC preferred. Knowledge: Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills ...
Hospice Registered Nurse RN Full Time
Franklin, TN · On-site
$40 - $43/hr
Participates in quality improvement, utilization review, and infection control activities as ... Requirements: * An active RN License in the state of application * Valid CPR * Valid Drivers ...
Hospice Registered Nurse RN Full Time
Franklin, TN · On-site
$40 - $43/hr
Participates in quality improvement, utilization review, and infection control activities as ... Requirements: * An active RN License in the state of application * Valid CPR * Valid Drivers ...
We are seeking a dedicated Registered Nurses (RN) to join our Behavioral Health ADMISSIONS team at ... utilization review processes to assure continuity for the most appropriate level of care for ...
We are seeking a dedicated Registered Nurses (RN) to join our Behavioral Health ADMISSIONS team at ... utilization review processes to assure continuity for the most appropriate level of care for ...
Registered Nurse (RN) Case Manager Director Job Type: Full-Time | Day Your experience matters ... Two years recent related clinical experience preferred in Utilization Review, Quality Improvement ...
Registered Nurse (RN) Case Manager Director Job Type: Full-Time | Day Your experience matters ... Two years recent related clinical experience preferred in Utilization Review, Quality Improvement ...
Internship Rn Utilization Review Nurse information
What is an Internship RN Utilization Review Nurse?
An Internship RN Utilization Review Nurse is a registered nurse who is in a training or internship phase to learn how to evaluate the necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves reviewing patient records, coordinating with healthcare providers, and ensuring that treatments meet established guidelines and insurance requirements. The internship provides hands-on experience in the field of utilization review, helping nurses transition from direct patient care to a more administrative or case management-focused role. It is an entry-level opportunity for RNs interested in healthcare quality and cost management.
What types of tasks and learning experiences can I expect as an Internship RN Utilization Review Nurse?
As an Internship RN Utilization Review Nurse, you will typically assist experienced utilization review nurses in evaluating patient records, verifying the necessity of medical procedures, and ensuring compliance with insurance or regulatory guidelines. You'll gain exposure to interdisciplinary communication by collaborating with physicians, case managers, and insurance representatives. This role provides valuable insight into how clinical decisions impact both patient outcomes and healthcare costs, helping you develop analytical and communication skills essential for future advancement. Expect to participate in chart reviews, learn about medical necessity criteria, and attend case discussions as part of your hands-on learning.
What are the key skills and qualifications needed to thrive as an Internship RN Utilization Review Nurse, and why are they important?
To thrive as an Internship RN Utilization Review Nurse, you need a solid foundation in nursing principles, clinical assessment, and case management, typically supported by an RN license and current enrollment in a nursing program. Familiarity with medical coding systems (like ICD-10 or CPT), electronic health records (EHRs), and utilization review software is often required. Strong analytical thinking, communication skills, and attention to detail set candidates apart in this role. These competencies are crucial for ensuring appropriate patient care, regulatory compliance, and effective resource utilization within healthcare organizations.
What is the difference between Internship Rn Utilization Review Nurse vs Utilization Review Nurse?
| Aspect | Internship Rn Utilization Review Nurse | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, internship or training program | RN license, certification in utilization review often preferred |
| Work Environment | Training setting, supervised, learning-focused | Clinical or office setting, independent review tasks |
| Job Responsibilities | Assisting in review processes, gaining experience | Performing utilization reviews, making coverage decisions |
Internship Rn Utilization Review Nurse is a training role for nursing students or new graduates gaining experience, while Utilization Review Nurse is a full-time professional responsible for evaluating medical necessity and coverage. The internship role focuses on learning, whereas the utilization review nurse performs independent assessments in healthcare settings.
What are the most commonly searched types of Rn Utilization Review Nurse jobs in Tennessee?
The most popular types of Rn Utilization Review Nurse jobs in Tennessee are:
What are popular job titles related to Internship Rn Utilization Review Nurse jobs in Tennessee?
For Internship Rn Utilization Review Nurse jobs in Tennessee, the most frequently searched job titles are:
- Evening Utilization Review Nurse
- Weekend Physician Advisor Utilization Review
- Contract Utilization Review Nurse
- No Experience Utilization Review Nurse
- Utilization Review Rn
- Remote Medical Record Review Nurse
- Remote Behavioral Health Utilization Review
- Evening Optum Health Utilization Review
- Part Time Utilization Review Nurse
- Medicare Review Nurse
What job categories do people searching Internship Rn Utilization Review Nurse jobs in Tennessee look for?
The top searched job categories for Internship Rn Utilization Review Nurse jobs in Tennessee are:
What cities in Tennessee are hiring for Internship Rn Utilization Review Nurse jobs?
Cities in Tennessee with the most Internship Rn Utilization Review Nurse job openings:
Part-time
Re-posted 15 days ago
Acadia Healthcare rating
6.2
Based on 191 frontline employees who took The Breakroom Quiz
698th of 898 rated healthcare providers
Job description
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
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About Acadia Healthcare
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Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Franklin, TN, US
Year founded
2005