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RN Utilization Management Post Acute Reviewer

Job ID: 4651
Facility: CHAPS Building, THNM-THN Utilization Managemnt
City: Greensboro

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Job Description

LOCATION<\/font><\/b>: CHAPS Building, <\/font>THNM-THN Utilization Managemnt <\/font>
<\/font>CITY<\/font><\/b>: Greensboro <\/font>
<\/font>
JOB DETAILS<\/b>:
Exempt: Yes | <\/font>FTE: 1.0 (40 hours/week) | Schedule: <\/font>M-F with every 6th Saturday | <\/font>On Call: <\/font>YES
<\/font>
JOB SUMMARY<\/b>:<\/font><\/span><\/p>

Accountable for coordinating, authorizing, monitoring and reporting all Post-Acute Inpatient Utilization Management activities. Works in tandem with RN Team Lead and physician reviewers for NOMNC, DENC and appeals for post-acute inpatient members. Provides routine on site visits to members in post-acute settings to ensure that high level appropriate services are being provided and coordinate post discharge care needs. Works in collaborative practice with the physician and other members of the health care team to meet patient-specific and age-related patient needs, linking cost resource management and quality to patient care. Demonstrates proficiency in the application of national and local clinical case review criteria and appropriate levels of care across the care continuum for managing complex cases and related episodic care events <\/span><\/font><\/p>

Completes established competencies for the position within designated introductory period. Develops strong working relationships with Post-Acute Providers.<\/span><\/font><\/p>


EDUCATION<\/b>:
<\/font><\/span><\/p>

Required: Graduate of accredited School of Nursing<\/span><\/font><\/p>

Preferred: Bachelors<\/span><\/font><\/p>


EXPERIENCE<\/b>:
<\/font><\/span><\/p>

Required:<\/span><\/font><\/p>

\u2022 Three (3) year\u2019s experience in Utilization Review, Discharge Planning and Medical Case Management in a post-acute care setting.<\/span><\/font><\/p>

\u2022 MDS certification highly desirable. <\/span><\/font><\/p>

\u2022 Strong organizational skills.<\/span><\/font><\/p>

\u2022 Knowledge of specific regulatory, managed care requirements related to NOMNC and DENC processes.<\/span><\/font><\/p>


LICENSURE/CERTIFICATION/REGISTRY/LISTING-REQUIRED<\/b>:<\/font><\/span><\/p>

Valid Driver's License<\/span><\/font><\/p>


<\/span><\/font><\/p>

Additional information on required licensure/certification/registry/listings:<\/b><\/span><\/font><\/p>

Required: Current North Carolina License for Registered Nurse<\/span><\/font><\/p>

<\/p>

Preferred: Bachelors or Master\u2019s Degree in Nursing; MDS certification<\/span><\/font><\/p>


Cone Health is an equal opportunity employer. If you require assistance with our online job submission process, please contact our team at 866-266-3767 to request an accommodation. <\/font><\/span><\/p>

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