Registered Nurse (RN) - Utilization Review

Up to $20,000 Sign-on Bonus Based on Eligibility

The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis.

 

• Utilization Management- Balances clinical and financial requirements and resources in advocating for patient needs with judicious resource management
• Payer Authorization - Assures the patient is in the appropriate status and level of care based on Medical Necessity and submits case for Secondary Physician review per Tenet policy
• Education - Ensures and provides education to physicians and the healthcare team relevant to the effective progression of care, appropriate level of care, and safe and timely patient transition
• Compliance - Ensures compliance with federal, state, and local regulations and accreditation requirement impacting case management scope of services
• Performs related duties as assigned

Required

• Education: Associates in Nursing required. Experience: 
• Certification:  Required qualifications include an active Registered Nurse license with at least two years acute hospital or Behavioral Health patient care experience

 

Preferred

• Education: BSN preferred



Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!

At Piedmont Medical Network - Rock Hill Hospital, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status