Utilization Management Registered Nurse in Greensboro, NC at Pride Health

Date Posted: 11/8/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Experience:
    Not Specified
  • Date Posted:
    11/8/2019

Job Description

A Utilization Management Registered Nurse is needed in Greensboro, NC for a 

Schedule: December Start, 8hr Days M-F, On call once every 10-12 weeks, 13 week contract.

Details:

  • Supports the Collaborative Utilization Management Model as a working partner with physicians, social workers, pharmacists, and other professional staff. 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.
  • Demonstrates a solid understanding of managed care trends, Medicare, and Medicaid regulations, reimbursement and the effect on utilization and outcomes of the different methods of reimbursement.
  • Establishes priorities during routine daily operations, addressing time-sensitive matters first, while also accomplishing day-to-day tasks and duties. Effectively triages tasks and events according to urgency level, impact on patients and outcomes desired under special conditions (e.g. during crises and emergencies). Makes choices that result in maximum completion of essential duties and minimum personal stress.
  • Ensures complete and accurate documentation in accordance with eligibility and benefits, clinical guidelines/criteria, and legal/regulatory requirements.
  • Identifies and refers cases to the Physician for Medical Review when services do not meet medical necessity criteria and/or appropriate level of care.

Requirements:

  • 3yrs or Utilization Management RN experience
  • BLS
  • URAC certification preferred 
  • NC or Compact State License

If you or someone you know is interested in this position, please contact Chelsie Anderson at 843-885-1212 or Chelsie.Anderson@pride-health.com

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