Cone Health, SW-Pt Acct Rev IntegrityCITY:
Exempt: Yes | FTE: 1.0 (40 hours/week) | Schedule: Mon- Friday 8a-5p | On Call: YESJOB SUMMARY:
The UR Quality Manager will assist the UR Senior Manager in the day-to-day functions of the utilization review clinical team including clinical staff hiring, training, competency assessments, daily work assignments and turnaround time adherence. This position will also be directly responsible for initiating, completing and reporting on UR denial and appeals processes. UR RN Quality Manager works in collaborative practice with the UR Senior Manager, Intake Team, Physician Reviewers, THN Care Management and external members of the health care team to meet patient specific and age-related patient needs, linking cost resource management and quality of patient care. UR Quality Manager may lead as well as be an active participant in process improvement activities across the continuum of care.EDUCATION:
Bachelor's degree in nursing from an accredited school of nursing, required.
Master's degree in Business or Healthcare related field, preferred.EXPERIENCE:
Required: Three (3) years of utilization review experience in the acute care area and/or health plan company experience. Two (2) or more years in a supervisory/leadership role. Working knowledge of computers and basic software applications including Microsoft Word, Excel, PowerPoint, etc.
Preferred: Three (3) or more years in Utilization Review utilizing national evidence based clinical support software. Working understanding and application or URAC or NCQA requirements for health plan utilization management. Strong demonstrated leadership and coaching skills.LICENSURE/CERTIFICATION/REGISTRY/LISTING:
Required: Current North Carolina RN license in good standing.
Preferred: MSN, URAC Certification
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.