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Overnight Rn Utilization Review Nurse Jobs in Tennessee

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Overview Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift ... Prepares and reviews necessary documentation for insurance utilization management processes and ...

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Overnight Rn Utilization Review Nurse information

What does an Overnight RN Utilization Review Nurse do?

An Overnight RN Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of medical services, procedures, and hospital admissions during the overnight shift. They review patient records, apply clinical guidelines, and collaborate with healthcare teams to ensure that care meets established standards and payer requirements. Their goal is to promote quality care while preventing unnecessary costs or hospital stays, often working with insurance companies and case management teams.

What are the key skills and qualifications needed to thrive as an Overnight RN Utilization Review Nurse?

To thrive as an Overnight RN Utilization Review Nurse, you need a current RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with healthcare documentation systems, utilization management software, and knowledge of regulatory guidelines such as Medicare and Medicaid are typically required. Excellent analytical thinking, communication, and decision-making skills help you collaborate with providers and advocate effectively for patients. These skills ensure accurate assessments, regulatory compliance, and optimal resource use during overnight hours when independent decision-making is critical.

What are some common challenges faced by an Overnight RN Utilization Review Nurse, and how can they be managed?

Overnight RN Utilization Review Nurses often work independently, reviewing medical records and ensuring appropriate patient care while adhering to insurance guidelines. Common challenges include limited access to on-site support staff and the need to make timely decisions with fewer resources available during night shifts. To manage these challenges, strong communication skills, detailed documentation, and familiarity with hospital protocols are essential. Leveraging remote communication tools and establishing clear escalation procedures can also help ensure effective collaboration with day teams and physicians.

What is the difference between Overnight Rn Utilization Review Nurse vs Overnight Rn Case Manager?

AspectOvernight Rn Utilization Review NurseOvernight Rn Case Manager
CertificationsRN license, Utilization Review certification (if applicable)RN license, Case Management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilities, primarily reviewing patient cases overnightHospitals, clinics, insurance companies, coordinating patient care and discharge planning overnight
Job FocusReviewing medical necessity, insurance coverage, and utilization of resourcesManaging patient care plans, discharge planning, and coordinating services

While both roles require RN licensure and involve patient care, the Overnight Rn Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance coverage overnight, whereas the Overnight Rn Case Manager concentrates on coordinating patient care and discharge planning during overnight shifts. Both roles are essential in healthcare settings but serve different functions within patient management and resource utilization.

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 cities in Tennessee are hiring for Overnight Rn Utilization Review Nurse jobs?

Cities in Tennessee with the most Overnight Rn Utilization Review Nurse job openings:

Overnight Rn Utilization Review Nurse jobs near you

RN-Utilization Review

Baptist Memorial Health Care Corporation

Memphis, TN • On-site

Full-time

This job post has expired 2 days ago. Applications are no longer accepted.

Baptist Memorial Health Care rating

7.3

Company rating: 7.3 out of 10

Based on 115 frontline employees who took The Breakroom Quiz

305th of 898 rated healthcare providers

Job description

Description
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
  • Utilization Review
  • Discharge planning
  • Readmission Reduction Participation
  • Payer Communication and denial reduction
  • Completes assigned goals.
Specifications
Experience
Minimum Required
  • RN with at least one (1) year of clinical experience
Preferred/Desired
  • RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
  • Diploma or Associate Degree in Nursing
Preferred/Desired
  • BSN or MSN
Training
Minimum Required
Preferred/Desired
  • Certified Case Manager
Special Skills
  • .
Minimum Required
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
  • RN
Minimum Required
  • RN
Preferred/Desired
  • RN;CCM;ACM

What Baptist Memorial Health Care employees say

Pay

Benefits

Hours and flexibility

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About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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