Utilization Review Nurse Coordinator (RN)-Atrium Health- Remote-FT Days

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Utilization Review Nurse Coordinator (RN)-Atrium Health- Remote-FT Days

Charlotte, NC, United States

Job ID: R243189

Shift: Various

Job Type: Regular

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Department:

11215 Behavioral Health Contract Management Group: Charlotte - Utilization Management

Status:

Part time

Benefits Eligible:

Yes

Hours Per Week:

24

Schedule Details/Additional Information:

Monday - Wednesday, 8 hour day time shift

Pay Range

$35.50 - $53.25

Major Responsibilities

• Identifies clinical, financial, and psychosocial needs of patients/families and provides leadership and guidance to the multidisciplinary team to develop an individualized plan of care.
• Ensures essential information and necessary forms are placed in the revenue cycle tool and available for the revenue cycle team and other disciplines.
• Provides necessary documentation and information to third party administrators as needed.
• Performs admission and concurrent reviews.
• Applies clinical guidelines during Admission and Concurrent reviews and identifies potential third-party denials. Works with multidisciplinary team to identify and implement alternative plans of care.
• Initiates and request authorizations for post-acute care as needed to facilitate care coordination.
• Refers pertinent cases to the Medical Director, Service Director, and/or Physician Advisor in a timely manner.
• Collaborates as needed with the physician to plan and implement medical and multidisciplinary plan(s) of care, utilizing clinical pathways when appropriate and available.
• Identify and escalate barriers and problems to the multidisciplinary team and leadership for intervention and resolution.
• Develops and maintains accurate case records of assigned cases. Documents in the patient's medical record according to department and facility standards.

Minimum Job Requirements

Education

Graduation from an accredited School of Nursing required. Bachelor's degree in nursing preferred. applicable state RN licensure required. Related experience preferred

Certification / License

Basic Life Support (BLS) for Healthcare Provider (HCP) per facility requirements

Prior utilization management and behavioral health experience preferred

Physical Requirements and Working Conditions

Works in an office setting, extensive walking throughout the facility. Prolonged periods of sitting reviewing medical records and documentation. Repetitive wrist motion and occasional lifting of 10-20 pounds. Requires frequent verbal and written communication in English. Intact sight and hearing with or without assistive devices are required.

DISCLAIMER

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Assists and collaborates with multidisciplinary team in providing specific clinical information that meets expectations of third-party payors; responsible for timely provision/flow of clinical information to/from third party payor and multidisciplinary team to ensure certification/approval of inpatient services. Provides clinical expertise/knowledge support to the payor specialist(s). Reviews clinical information prior to sending to payor as needed to ensure information meets acute clinical care guidelines.

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