Description

Hourly Wage Estimate: $41.90 - $62.87 / hour

Learn more about the benefits offered ( https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards ) for this job.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Introduction

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Utilization Management RN today with HCA Healthcare.

Benefits

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.

• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.

• Free counseling services and resources for emotional, physical and financial wellbeing

• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)

• Employee Stock Purchase Plan with 10% off HCA Healthcare stock

• Family support through fertility and family building benefits with Progyny and adoption assistance.

• Referral services for child, elder and pet care, home and auto repair, event planning and more

• Consumer discounts through Abenity and Consumer Discounts

• Retirement readiness, rollover assistance services and preferred banking partnerships

• Education assistance (tuition, student loan, certification support, dependent scholarships)

• Colleague recognition program

• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)

• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

Note: Eligibility for benefits may vary by location.

Come join our team as a(an) Utilization Management RN. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!

Job Summary and Qualifications

The UM Nurse’s primary function is to ensure timely review of referral requests, procedure, and pre-certification requests in accordance with established policy. The position is responsible for the appropriate review of authorization requests, concurrent review, following regulatory guidelines, maintaining performance standards and keeping the UM Manager informed of member/provider issues.

What you will do:

· Review authorization requests, applying clinical criteria based on nationally standardized guidelines and UM criteria in establishing authorization determinations

· Prepare and present authorization requests with supporting documentation for review with the Medical Director

· Assume responsibility for ensuring timely reviews of authorization requests in accordance with written policy, regulatory, and Health Plan guidelines

· Apply case management skills to members who have been identified as high risk for hospital readmissions through telephonic case management Perform other duties as assigned

What you will need:

· Knowledge of Commercial, Medicare, and Medi-Cal HMO lines of business

· Knowledge of medical coding practices

· Working knowledge of medical standards of practice or experience with using UM medical criteria (i.e. Milliman and InterQual) required

· Strong Computer experience including using the internet to research clinical and non-clinical issues required

· Current California RN or LVN license required

· Minimum three to five years of experience in Managed Care, Provider Office, or Utilization Review organization required

Physician Services Group (https://careers.hcahealthcare.com/pages/physician-services) is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Utilization Management RN opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.