CHAPS Building, THNM-THN Utilization ManagemntCITY:
Exempt: Yes | FTE: 1.0 (40 hours/week) | Schedule: M-F with every 6th Saturday plus on call | On Call: YESJOB SUMMARY: 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
Completes established competencies for the position within designated introductory period. Develops strong working relationships with Post-Acute Providers.
EDUCATION: Required: Graduate of accredited School of NursingPreferred: Bachelors
• Three (3) year's experience in Utilization Review, Discharge Planning and Medical Case Management in a post-acute care setting.
• MDS certification highly desirable.
• Strong organizational skills.
• Knowledge of specific regulatory, managed care requirements related to NOMNC and DENC processes.
Valid Driver's License | Valid Driver's License
Required: Current North Carolina License for Registered NursePreferred: Bachelors or Master's Degree in Nursing; MDS certification
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