Cone Health, SW-Pt Acct-Utilization ReviewCITY:
Exempt: Yes | FTE: 1.0 (40 hours/week) | Schedule: M-F 11:00A-7:30P | On Call: NOJOB SUMMARY:
Performs admission and continued stay utilization reviews and discharge screening to assure the medical necessity of hospital admission, appropriate level of care, continued stay and supportive services, and to examine delays in the provision of services. Coordinates care transitions from inpatient to the next level of care. Collaborates with attending physicians, advanced practice providers, and/or Department Medical Directors concerning status and/or medical necessity issues. Follows departmental policy to escalate cases to second level review when criteria is in question. The UR RN consistently interacts with physicians, nurses, revenue cycle services, other patient caregivers, and coding professionals to ensure that medical record documentation accurately reflects the level of services rendered to patient and the clinical information utilized in profiling and reporting outcomes is completed. Monitors and evaluates care to ensure care is medically necessary, provided in the appropriate setting, and generated according to governmental and regulatory agency standards.EDUCATION:
Required: Bachelor's in Nursing from an accredited school of nursing
Preferred: Master's degree in business or healthcare related fieldEXPERIENCE:
Required: Three (3) years of utilization review experience in the acute care area and/or health plan company experience. 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 requirements for health plan utilization management.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.