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Utilization Management RN
Our promise to you:
Continuing your journey with AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
All the benefits and perks you need for you and your family:
Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
Paid Time Off from Day One
403-B Retirement Plan
4 Weeks 100% Paid Parental Leave
Career Development
Whole Person Well-being Resources
Mental Health Resources and Support
Pet Benefits
Job Description:
- Monitor admissions and perform initial and continued stay medical necessity reviews.
- Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement.
- Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials.
- Build relationships to promote interdisciplinary collaboration.
- Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization.
Knowledge, Skills, and Abilities:
• Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
• Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
• Ability to understand differences between notification, reference, and authorization numbers.
• Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.
• Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff.
Education:
• Associates of Nursing [Required]
• Bachelor of Nursing [Preferred]
Field of Study:
• N/A
Work Experience:
• 3+ years clinical nursing [Required]
• 5+ years clinical nursing in an acute care setting [Preferred]
• Experience working in electronic health records [Preferred]
• Utilization Management or Case Management [Preferred]
Additional Information:
• N/A
Licenses and Certifications:
• Registered Nurse (RN) [Required] AND
• Accredited Case Manager (ACM) [Preferred] OR
• Certified Case Manager (CCM) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/msy4mja2
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Qualification Requirements:
Associate's of Nursing (Required), Bachelor's of NursingAccredited Case Manager (ACM) - EV Accredited Issuing Body, Certified Case Manager (CCM) - EV Accredited Issuing Body, Registered Nurse (RN) - EV Accredited Issuing BodyWork Shift:
Day (United States of America)Pay Range:
$68,132.50 - $119,520.35This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.