8 days old

Utilization Review Nurse RN PRN

HCA Healthcare
Tallahassee, FL 32301
  • Jobs Rated


SHIFT: Work From Home


Utilization ReviewNurse (RN) – HCA North Florida Division



Provideclinical information to patient Insurance Plans according to the terms of thecontract, receive authorization / certification for the stay, work concurrentdenials, determine the correct patient status and communicate to thefacilities, follow the X-Code process per HCA policy, maintain communicationwith the facility case managers, physicians and the Insurance Plans. Thisposition will focus on initial and continued stay utilization review anddenials to include assessment of medical records for appropriateness, level ofcare provided, including assessment of treatment modalities, medications,services and application of treatment protocols. A team approach with thefacility Case Management team is critical.


SCHEDULE: Although this is awork-from-home position, candidates must live within the HCA North Florida Division and reside within driving distance of an HCA facility in the Orlando or Gainesville, FL areas. Schedule requirements are variable per UR department needs.  Some weekend and / or holiday work will berequired.



  • B.S.in Business Administration, Nursing or Healthcare Administration preferred orequivalent work experience
  • RegisteredNurse (RN) license required
  • Certificationin Case Management or UR preferred or is willing to pursue in the first year(or when eligible)
  • InterQualexperience strongly preferred, minimum of oneyear.
  • Acutecare hospital experience preferred.
  • ThirdParty Payer and Denial Management experience a plus.
  • Excellentpersonal computer skills (MS Outlook, MS Office, Midas, Meditech, OnBase DOSbased and other related software) required


Special Qualifications:  Able to work independently with littlesupervision. Ability to communicate clearly, professionally and concisely. Excellentcritical thinking skills. Strong organizational skills and able to proactivelyprioritize needs and effectively manage resources. Ability to work within aTeam. Excellent written and oral communication skills along with excellentinterpersonal skills. Position requires candidates with determined andassertive communication skills.


About HCA:

Nashville-based HCAHealthcare is one of the nation's leading providers of healthcare services,comprising 184 hospitals and approximately 2,000 sites of care, includingsurgery centers, freestanding ERs, urgent care centers, and physician clinics,in 20 states and the United Kingdom. With its founding in 1968, HCA Healthcarecreated a new model for hospital care in the United States, using combinedresources to strengthen hospitals, deliver patient-focused care and improve thepractice of medicine. HCA Healthcare has conducted a number of clinicalstudies, including one that demonstrated that full-term delivery is healthierthan early elective delivery of babies and another that identified a clinicalprotocol that can reduce bloodstream infections in ICU patients by 44 percent.HCA Healthcare is a learning health system that uses its more than 31 millionannual patient encounters to advance science, improve patient care and savelives. 


HCA affiliatedfacilities in the North Florida Division are a part of aquality healthcare network in North Florida with 14 affiliated hospitals, 5surgery centers, and two consolidated service centers. Together, the network hasover 3,100 beds, employs more than 14,000 individuals, and has over 4,200physicians on staff.


AnEEO/AA Employer M/F/V/D


Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.



Jobs Rated Reports for Registered Nurse

Posted: 2019-12-03 Expires: 2020-01-02

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Utilization Review Nurse RN PRN

HCA Healthcare
Tallahassee, FL 32301

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

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