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Utilization Review Assistant Jobs in Tennessee (NOW HIRING)

Vertek Staffing

CDI Specialist

Franklin, TN · Remote

$33.50 - $45/hr

... Utilization Review, and clinical teams to promote complete and accurate documentation. * Ensure documentation supports appropriate MS-DRG and APR-DRG assignment. * Assist with reducing denials ...

Centralized Review

Physician Advisor Coordinator

Franklin, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... assist in establishing communication between Physician Advisors and in-house insurance Medical ... Utilization Review Services (URS) team, Pre-bill Denial Units (PDU), and on Authorization and ...

Centralized Review

Physician Advisor Coordinator

Nashville, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... assist in establishing communication between Physician Advisors and in-house insurance Medical ... Utilization Review Services (URS) team, Pre-bill Denial Units (PDU), and on Authorization and ...

Centralized Review

Physician Advisor Coordinator

Lebanon, TN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... assist in establishing communication between Physician Advisors and in-house insurance Medical ... Utilization Review Services (URS) team, Pre-bill Denial Units (PDU), and on Authorization and ...

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All JobsUtilization Review JobsUtilization Review Assistant JobsUtilization Review Assistant Jobs in Tennessee

Utilization Review Assistant information

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

What are the most commonly searched types of Utilization Review jobs in Tennessee?

The most popular types of Utilization Review jobs in Tennessee are:

What are popular job titles related to Utilization Review Assistant jobs in Tennessee?

For Utilization Review Assistant jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Utilization Review Assistant jobs in Tennessee look for?

The top searched job categories for Utilization Review Assistant jobs in Tennessee are:

What cities in Tennessee are hiring for Utilization Review Assistant jobs?

Cities in Tennessee with the most Utilization Review Assistant job openings:

Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in Tennessee as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

CDI Specialist

Vertek Staffing

Franklin, TN • Remote

$33.50 - $45/hr

Contractor

Re-posted 25 days ago

Job description

CDI Specialist - Remote

Acute Care Hospital Experience Required

Required Education
  • High School Diploma required with submission
Required Certifications & Licensure

Online certification verification required with submission.

Required:

  • Active, unrestricted Registered Nurse (RN) license

Preferred Certifications:

  • Certified Clinical Documentation Specialist (CCDS) - ACDIS
  • Certified Documentation Improvement Practitioner (CDIP) - AHIMA
  • Certified Coding Specialist (CCS) - AHIMA
  • Registered Health Information Administrator (RHIA) - AHIMA
  • Registered Health Information Technician (RHIT) - AHIMA
Schedule
  • Monday - Friday
  • Occasional weekend coverage may be required based on client needs
Position Summary

The CDI Specialist is responsible for improving the overall quality and completeness of clinical documentation within the medical record. Through concurrent review of patient records, the CDI Specialist collaborates with physicians, nursing staff, coding professionals, case management, and other healthcare team members to ensure documentation accurately reflects severity of illness, risk of mortality, quality measures, and resource utilization.

The CDI Specialist identifies opportunities for documentation clarification through compliant physician queries and helps ensure documentation supports accurate coding, reimbursement, quality reporting, and denial prevention.

This role requires strong clinical knowledge, critical thinking skills, and a thorough understanding of ICD-10-CM/PCS coding guidelines, MS-DRG assignment, APR-DRG methodologies, and regulatory requirements.

The CDI Specialist will work collaboratively with HIM, Coding, Case Management, Utilization Review, Physician Advisors, and providers to support accurate and complete clinical documentation.

Key Responsibilities
  • Conduct concurrent reviews of inpatient medical records to identify documentation improvement opportunities.
  • Initiate compliant physician queries to clarify diagnoses, procedures, severity of illness, risk of mortality, and present-on-admission indicators.
  • Collaborate with Coding, HIM, Case Management, Utilization Review, and clinical teams to promote complete and accurate documentation.
  • Ensure documentation supports appropriate MS-DRG and APR-DRG assignment.
  • Assist with reducing denials through accurate clinical documentation and physician education.
  • Monitor documentation trends and identify opportunities for process improvement.
  • Participate in physician education initiatives related to documentation best practices.
  • Maintain productivity and quality standards established by the client.
  • Stay current on regulatory requirements, coding guidelines, and CDI best practices.
  • Assist leadership with special projects and additional duties as assigned.
Required Experience
  • Active RN license
  • Acute Care Hospital CDI experience required
  • Experience performing concurrent inpatient chart reviews
  • Experience writing compliant physician queries
  • Strong understanding of clinical documentation improvement principles
  • Knowledge of MS-DRGs, APR-DRGs, Severity of Illness (SOI), and Risk of Mortality (ROM)
  • Experience collaborating with physicians and interdisciplinary teams
Preferred Experience
  • CCDS and/or CDIP certification
  • Strong understanding of ICD-10-CM/PCS coding guidelines
  • Experience with mortality reviews, quality initiatives, and denial prevention
  • Experience with Epic, Cerner, Meditech, or other major EMR systems
 
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About Vertek Solutions

Sourced by ZipRecruiter

Vertek Solutions is a boutique staffing firm that specializes in recruiting top level IT talent who can enhance our clients’ teams. Our team works every day to foster relationships with both our consultants and clients to understand their needs and ensure that we are providing a solution that is mutually beneficial.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

Franklin, TN, US

Year founded

2006

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