CHAPS Building, THNM-THN Utilization ManagemntCITY:
Exempt: Yes | FTE: 1.0 (40 hours/week) | Schedule: M-F 8am - 5pm, oncall 1 every 6-10 weeks | On Call: YESJOB SUMMARY:
Accountable for coordinating, authorizing, monitoring and reporting all pre service, concurrent, post service retro reviews associated with Inpatient Utilization Management activities. Works in tandem with RN Team Lead and physician reviewers for NOMNC, DENC and appeals for inpatient members. 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. Completes established competencies for the position within designated introductory period. 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. Ensures compliance to all delegated and regulatory requirements.EDUCATION:
Required: Graduate of accredited School of Nursing;
Preferred: Bachelors of Nursing
*May substitute experience for degreeEXPERIENCE:
Required: Three (3 years) utilization management experience with an acute or post-acute provider, health plan or other care company experience. Working knowledge of computers and basic software applications used in job functions such as word processing, processing, graphics, databases, spreadsheets, etc.
Preferred: Three (3) years' experience in Utilization Review, Discharge Planning and Medical Case Management in a hospital or post-acute care setting. Strong analytical and organizational skills. Working knowledge and ability to apply professional standards of practice in work environment. Knowledge of specific regulatory, managed care requirements.LICENSURE/CERTIFICATION/REGISTRY/LISTING:
Possession of current North Carolina State License for Registered Nurse
URAC recognized certification
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