Guilford Co Behavioral Health Center, BH-OP Ctr Adm Maple StCITY:
Greensboro, NCJOB DETAILS:
Exempt: Yes | FTE: 0.3 (12 hours/week) | Schedule: Saturday & Sunday | 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.
Bachelors, Nursing, required
Masters, Healthcare Related Field, preferred
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.
Required: Current North Carolina RN license in good standing
Preferred: MSN, URAC Certification
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