RN Utilization Review - Care Management

JOB TITLE: RN Utilization Review 

DEPT: Care Management 

LOCATION: Maury Regional Medical Center - Columbia, TN

SHIFT: PRN As Needed

MAURY REGIONAL HEALTH:

At Maury Regional Health, patients are at the heart of everything we do. We're committed to clinical excellence and compassionate care, offering exceptional service. As a top-rated organization, we foster an inclusive, collaborative work environment where innovation and patient care lead the way.

JOB SUMMARY:

The Utilization Review Nurses will review medical records of patients assigned and accurately apply the clinical decision support tool to establish medical necessity and appropriateness of continued stays. The UR Nurse will provide clinical data to insurers in a timely manner as outlined in the insurer’s contracts or the hospital’s UM Plan. The UR Nurse concurrently manages denials by providing timely denial response, coordinating peer to peer discussions, and escalating denials in accordance with dispute resolution processes. 

JOB REQUIREMENTS:

· Current and Valid Licensure as Registered Nurse in TN Required

· 3 Years of Clinical Nursing Experience in a Hospital/Clinical Setting Preferred 

· 1 Year of Care Manager Experience Preferred 

WHY MAURY:

· 2025 Best Place to Work & 2024 Best Place for Working Parents

· Medical, Dental, Vision, Retirement Plans & PTO

· Educational Assistance, Tuition Reimbursement & Career Advancement Navigation

· Employee Discounts

· Childcare Services – Hospitots

· Adoption Assistance

For more information: About Maury Regional Health

MISSION, VISION & VALUES:

MISSION: Clinical excellence. Compassionate care. Every patient. Every day.

VISION: To be the trusted choice for health and wellness in southern Middle Tennessee by delivering a safe, seamless and patient-centered experience.

VALUES:

W – Wholeness: Wellness-centered care of mind, body & spirit for our patients & health care team.
E – Empathy: Understanding the feelings of others as we walk with them on their path to wellness.

C – Community: Creating relationships, connections & trust.
A – Advocacy: Defending the rights of all to be heard.
R – Respect: Treating everyone with dignity & respect.
E – Engagement: Actively involving all stakeholders in creating better health outcomes for southern Middle Tennessee.

STRATEGIC ANCHORS:

· Quality patient care

· Highly effective teams

· Stewardship of resources

· Innovative culture

Maury Regional Health is committed to the principles of Equal Employment Opportunity in all aspects of the employer/employee relationship. Maury Regional Health grants equal employment opportunities to all qualified persons without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), national origins (including ancestry), genetic information, disability, age, military/national guard/veteran status, sexual orientation, gender identity, or gender expression, or other status protected by state or federal law. Statements made by applicants for employment on this application form will be checked for accuracy. Maury Regional Health campuses are tobacco-free. All tobacco use is prohibited.