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Quality/Post Payment Review Nurse

Job ID: 18237
Facility: CHAPS Building
City: Greensboro

Date Posted: 2021-04-15 06:43:31 UTC
2021-03-13 07:25:36 UTC

This job posting is no longer active.

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Job Description

LOCATION: CHAPS Building, THNM-THN Utilization Managemnt
CITY: Greensboro, NC

JOB DETAILS:
Exempt: Yes | FTE: 1.0 (40 hours/week) | Schedule: Monday - Friday, 8:00am - 5:00pm | On Call: Yes

JOB SUMMARY:

Under general direction, designs, coordinates and conducts quality assurance and improvement activities for Utilization Management pre-authorizations and post-service payment reviews. Works collaboratively with UM staff, Health Plan and TPA (Claims Department) to identify, quantify and measure opportunities for improvement. Projects and activities are focused on CMS Medicare Managed Care UM requirements and NCQA standards for Health Plans. Supports the philosophy and mission of THN by facilitating performance improvement activities linked to the strategic plan. Scope of responsibilities requires knowledge of methods of investigation and review, statistical analysis and reporting, performance measures, performance improvement techniques and the frequent use of discretion, initiative and sound clinical judgement.

EDUCATION:

Bachelor's in Nursing from an accredited school of nursing, required.

EXPERIENCE:

Required:
4 years utilization management
2 years quality assurance and improvement

Preferred:
Health Plan UM experience

LICENSURE/CERTIFICATION/REGISTRY/LISTING:

Required: Current North Carolina RN license in good standing
Preferred: Certified Professional in Healthcare Quality (CPHQ)

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.
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