Utilization Review Registered Nurse at Actalent in Memphis, TN

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Job Description

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  Job Title: Utilization Review Registered Nurse
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  Job Description
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 Hiring within the Case Management team in a role that supports collaborative efforts to facilitate quality patient care. This position integrates and coordinates various aspects of service delivery, care facilitation, payer authorizations, service access, discharge and post-discharge activities, and utilization review. You will identify patients that meet criteria for case management services using an appropriate screening and assessment process, communicate necessary information to stakeholders, educate patients and families, plan effectively to meet patient needs, manage authorizations and length of stay, and promote efficient utilization of resources. Additionally, you will maintain reliable systems to document, track, and monitor assigned cases and perform other job functions as assigned or requested.
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 Hard Skills
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   Case management
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   Utilization review
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   Patient care facilitation
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   Authorization management
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   Resource utilization
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 Soft Skills
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   Effective communication
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   Educating patients and families
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   Collaborative teamwork
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   Strategic planning
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   Reliable documentation
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 Work Site
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   This is a fully on-site position in Memphis, Tennessee.
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 Work Environment
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   Located in northeast Shelby County, serving a diverse community for over four decades, our 246-bed hospital prioritizes high-quality, community-focused care with a personalized approach.
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  About Actalent
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 Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
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 Diversity, Equity &amp; Inclusion
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 At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&amp;I are embedded into our culture through:
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   Hiring diverse talent
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   Maintaining an inclusive environment through persistent self-reflection
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   Building a culture of care, engagement, and recognition with clear outcomes
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   Ensuring growth opportunities for our people
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 The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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 If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
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AI Powered Job Insights

Exciting opportunity for a Utilization Review Registered Nurse! Actalent is seeking a dedicated healthcare professional to join their Case Management team in Memphis, TN, to enhance the quality of patient care through effective collaboration and resource management.

📍 Location: Memphis, TN  
đź’Ľ Position: Utilization Review Registered Nurse  
⏰ Type: Contract  
đź“… Date Posted: Not specified  

Role Summary:  
- Integrates and coordinates service delivery and care facilitation.  
- Manages payer authorizations, service access, discharge, and post-discharge activities.  
- Identifies patients eligible for case management services through screening and assessment.  

What You'll Do:  
- Communicate essential information to stakeholders and educate patients and their families.  
- Plan effectively to meet patient needs and manage authorization processes.  
- Maintain reliable documentation systems to track and monitor assigned cases.  

What's Needed:  
- Hard Skills:  
  - Case management  
  - Utilization review  
  - Authorization management  
  - Patient care facilitation  
  - Resource utilization  

- Soft Skills:  
  - Effective communication  
  - Collaborative teamwork  
  - Strategic planning  
  - Reliable documentation  

Work Environment:  
- Located in a diverse community, serving for over four decades at a 246-bed hospital dedicated to personalized, community-focused care.  

Actalent is committed to diversity, equity, and inclusion, fostering a culture that supports growth and recognition. They are an equal opportunity employer, encouraging applications from all qualified candidates.

Top Interview Questions

  • Q: Can you describe your experience with utilization review and how you approach evaluating the necessity of patient care services?

    A: I have over five years of experience conducting utilization reviews in a hospital setting. My approach involves thoroughly reviewing patient records and treatment plans against established criteria to determine the necessity of services. I engage with healthcare providers to discuss treatment goals and collaborate to ensure that patient care is both clinically appropriate and cost-effective, while always prioritizing patient outcomes.

  • Q: How do you ensure effective communication with stakeholders during the case management process?

    A: Effective communication is vital in case management. I utilize clear and consistent updates through emails and meetings to keep all stakeholders informed about patient progress and changes in care plans. Additionally, I document all communications in the patient’s file for transparency. I also strive to educate patients and families about their treatment plans, which fosters collaboration and adherence to care.

  • Q: Can you give an example of a challenging case you managed and how you influenced positive patient outcomes?

    A: In one case, I managed a patient with complex medical needs requiring coordination among multiple specialists. I facilitated regular interdisciplinary meetings, coordinated authorizations, and maintained close communication with the patient’s family to address their concerns. Ultimately, this proactive approach helped reduce the patient’s length of stay by 20% and ensured they received comprehensive care tailored to their needs.

  • Q: What strategies do you apply to manage authorizations and resource utilization effectively?

    A: I employ a systematic approach to manage authorizations by creating checklists to track necessary documentation and timelines. This aids in preventing delays. I also frequently analyze resource utilization trends through data reports, which allows me to identify areas for improvement. Collaborating with financial departments helps ensure that we maintain efficiency while adhering to budgetary constraints.

  • Q: Describe how you would handle a situation where a patient's insurance denies authorization for necessary treatment.

    A: In such scenarios, I would first carefully review the denial reason and the patient's clinical evidence. I would then reach out to the insurance company to discuss the case, presenting any supporting documentation and advocating for the patient’s needs. If necessary, I would collaborate with the healthcare provider to appeal the decision and explore alternative solutions or treatments that align with the insurance’s coverage guidelines.

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