CHAPS Building, THNM-THN Utilization ManagemntCITY:
Exempt: Yes | FTE: 1.0 (40 hours/week) | Schedule: M-F 8-5p | On Call: YESJOB SUMMARY:
The UM RN Team Lead will assist the VP of Utilization Management in the day to day functions of the UM 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 UM denial and appeals processes. UM RN Team Lead works in collaborative practice with the UM Operations 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. RN UM Team Lead may lead as well as be an active participant in process improvement activities across the continuum of care.EDUCATION:
Required: Education Graduate of an accredited School of Nursing; BSN required
Preferred: Master's Degree in Business or Health related field preferredEXPERIENCE:
Required: Three (3) years of utilization management 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 word processing, Excel, PowerPoint, etc.
Preferred: Three (3) or more years in Utilization Review utilizing national evidenced based clinical support software. Working understanding and application of URAC or NCQA requirements for health plan utilization management. Strong demonstrated leadership and coaching skills.LICENSURE/CERTIFICATION/REGISTRY/LISTING:
Valid Driver's License | Valid Driver's License
Current North Carolina RN license in good standing.
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.