Utilization Review Nurse

1 week ago

Brookhaven GA, United States Children's Healthcare of Atlanta Full time
Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).

Work Shift

Day

Work Day(s)

Monday-Friday, Variable

Shift Start Time

8:00 AM

Shift End Time

4:00 PM

Worker Sub-Type

PRN

Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children’s.

Job Description

Participates as a member of a multidisciplinary team in completing pre-screening assessments of prospective patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary documentation and communication with internal and external customers.

This role is PRN to work 8 hours/week but open to offering more. Will be remote after Training/Orientation is completed (6-8 weeks/2-3 days week). Occasional meetings/trainings onsite at Support Center will occur and need to be attended

Experience

  • 3 years of RN experience in a healthcare setting

Preferred Qualifications

  • Bachelor of Science in Nursing
  • Previous experience in extensive case management preferred
  • 2 years of experience in hospital or insurance related utilization review

Education

  • Graduation from an accredited school of nursing

Certification Summary

  • Licensure as a Registered Nurse in the single State of Georgia or Multi-State through the Enhanced Nurse Licensure Compact

Knowledge, Skills, And Abilities

  • Working knowledge of financial aspects of third-party payors and reimbursement
  • Effective decision-making/problem-solving skills
  • Demonstration of creativity in problem-solving
  • Must possess above-average computer skills
  • Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of employment

Job Responsibilities

  • Provides clinical information to insurance companies as needed for completion of pre-certification process as noted in Children's Healthcare of Atlanta utilization management plan.
  • Evaluates all patients, including critical care, for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third-party information within 24 hours or next business day.
  • Initiates and facilitates physician communications relative to utilization review process when indicated without prompting and follows up to ensure completion, including peer-to-peer reviews, securing admission orders, and reporting quality issues.
  • Reviews concurrently all inpatients, including critical care, every three days or sooner if payor requests, including information regarding patient's medical condition, intensity of services being utilized, treatment plan, and established review criteria.
  • Ensures all pertinent information is documented into various systems for utilization review process.
  • Gathers and reviews relevant medical information and documents utilization review process outcome based on system accepted utilization criteria on the accepted current review forms and in computer systems.
  • Supports organizational efforts to ensure accurate capture of admission status and level of care using Epic and escalating cases for status change where necessary.
  • Refers denied cases to appropriate personnel and provides assistance and/or clinical support to aid in appeal process.
  • Serves as resource to Case Management for facilitation of patients moving to appropriate level of care and notifying when patients no longer meet medical necessity to aid in discharge planning.
  • Meets productivity (10-12 reviews/day) and quality assurance (95%) standards and demonstrates utilization review proficiency with the successful completion and passing of McKesson Interrater Reliability testing.
  • Attends all required onsite, telephonic, and mandatory department meetings.
  • Participates in department activities to help promote utilization review process, aids in denial prevention, and serves as resource to peers and team members.

Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

1575 Northeast Expy NE

Job Family

Nursing-Non Bedside

  • Utilization Review Nurse

    4 weeks ago

    Brookhaven, United States Children's Healthcare of Atlanta Full time

    JOB DESCRIPTION Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Monday-Friday, Variable Shift Start Time 8:00 AM Shift End Time 4:00 PM Worker Sub-Type PRN Children’s is one of the...

  • Utilization Review Nurse

    3 weeks ago

    Brookhaven, United States Children's Healthcare of Atlanta Full time

    JOB DESCRIPTION Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Monday-Friday, Variable Shift Start Time 8:00 AM Shift End Time 4:00 PM Worker Sub-Type PRN Children’s is one of the...

  • Clinical Review/Utilization Nurse

    2 weeks ago

    Brookhaven, United States Children's Healthcare of Atlanta Full time

    Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).Work Shift VariableWork Day(s) VariableShift Start Time 8:00 AMShift End Time 4:00 PMWorker Sub-Type PRNChildren’s is one of the nation’s leading children’s hospitals. No...

  • Clinical Review/Utilization Nurse

    3 weeks ago

    Columbus, GA, United States Children's Healthcare of Atlanta Full time

    Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Variable Work Day(s) Variable Shift Start Time 8:00 AM Shift End Time 4:00 PM Worker Sub-Type PRN Children’s is one of the nation’s leading children’s...

  • RN - Registered Nurse / Graduate Nurse -Medical Care

    1 week ago

    Brookhaven, GA, United States Children's Healthcare of Atlanta Full time

    Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Monday-Friday, Variable Shift Start Time Shift End Time PRN Children's is one of the nation's leading children's hospitals. No matter the role, every...

  • Travel Nurse RN

    2 weeks ago

    Roswell, GA, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Roswell, Georgia.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose adventure...

  • Private Duty Nurse LPN

    4 weeks ago

    Brookhaven, United States Aveanna Healthcare Full time

    Licensed Practical Nurse (LPN)*Now Offering Paid Time Off (PTO) Benefits*Aveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring compassionate Licensed Practical Nurses (LPN) to provide skilled nursing care to patients in the home setting.  We are the hearts of 30,000 caregivers and trusted by over 33,000...

  • RN - Registered Nurse / Graduate Nurse -Medical Care

    3 weeks ago

    Columbus, GA, United States Children's Healthcare of Atlanta Full time

    Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Shift Start Time Shift End Time PRN Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an...

  • Physical Therapist

    2 weeks ago

    Brookhaven, United States HealthPRO Heritage Full time

    Overview Full-time, Part-time or PRN Outpatient Physical Therapist SNF- South Setauket, NY At HealthPro Heritage we hire people who share our vision, who work diligently and provide the kind of care that will help change patient's lives for the better. As an Associate, your dedication and commitment deserve respect and recognition. If you're looking for a...

  • Energy Project Manager

    3 weeks ago

    Brookhaven, United States Actalent Full time

    Looking for an immediate Energy Project Manager for a hybrid role primarily based on Long Island. The ideal candidate will have experience with energy calculations, prior end client communication experience, and 10 years of experience. Description: + Oversees scheduling, budgeting, and construction management of projects consistent with predetermined plans,...

  • Physician Assistant

    6 days ago

    Brookhaven, United States AltaStaff Full time

    ***This is a position with Face-to-Face assessments. We are hiring for Long Island NY*** ***Offering $95.00 hourly*** ***Flexible Schedule*** AltaStaff is currently hiring 1099 Independent Contractors - Physician Assistants PA-C to review UAS Assessments all over NYS! Join our dynamic team! JOB SUMMARY Responsible for reviewing and making recommendations on...

  • Supervisor Revenue Integrity

    2 weeks ago

    Brookhaven, United States Northside Hospital Full time

    Overview Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today. Responsibilities ...

  • Senior Financial Analyst

    4 weeks ago

    Brookhaven, United States firstPRO 360 Full time

    We are partnering with a client located in Brookhaven, GA looking for a Senior Financial Analyst. This role is a hybrid position working in the office 3 days per week. We are looking for 5+ years of Analyst experience and strong communication skills.ResponsibilitiesBuild annual budgets and quarterly financial forecastsAssist with the preparation and...

  • Senior Financial Analyst

    4 weeks ago

    Brookhaven, United States firstPRO 360 Full time

    We are partnering with a client located in Brookhaven, GA looking for a Senior Financial Analyst. This role is a hybrid position working in the office 3 days per week. We are looking for 5+ years of Analyst experience and strong communication skills.ResponsibilitiesBuild annual budgets and quarterly financial forecastsAssist with the preparation and...

  • Physical Therapist

    2 weeks ago

    Brookhaven, United States HealthPRO Heritage Full time

    Overview Full-time, Part-time or PRN Outpatient Physical Therapist Retirement Community- South Setauket, NY What makes us the best choice for your career? At HealthPRO-Heritage we have a higher calling with regards to our patients, team members and clients. We create meaningful relationships and have opportunities for every stage of your career. We come...

  • Sales Associate

    4 weeks ago

    Brookhaven, United States Hibbett Retail, Inc. Full time

    Job DescriptionJob Description00543 Brookhaven, MSLE_301 Hibbett Retail, Inc.Job Title: Sales AssociateDepartment: OperationsFLSA Status: Non-ExemptReports To: Store ManagerSUMMARYThe Sales Associate is responsible for assisting the store's management staff with providing quality customer service. The Sales Associate is knowledgeable in each product area...

  • HVAC Mechanic

    2 months ago

    Brookhaven, United States Amneal Pharmaceuticals, Inc. Full time

    Job Summary The HVAC Mechanic is responsible for maintaining all HVAC systems which includes Air Handling Units, Humidification/dehumidification systems, Chillers, Fan coil Units, Water source heat pumps, Refrigeration units, Heat exchangers, Chilled & Hot water distribution, Building Management System, Dust collectors units & Vacuum units of the facility...

  • PRN Occupational Therapist Assistant

    1 week ago

    Brookhaven, Georgia, United States Empire Care Centers Full time

    Empire Care Centers - Join Our Team as an Occupational Therapist (OT) at Sandy Springs Center for Nursing and HealingCompetitive Compensation and Comprehensive Benefits Await You in Our Warm and Caring Environment.At Sandy Springs Center for Nursing and Healing, we believe that the quality of care we provide to our patients is inseparable from the support...

  • Physician - Emergency Medicine Job in Mississippi

    1 month ago

    Brookhaven, United States Hayman Daugherty Associates, Inc Full time

    Job Overview Exciting Opportunity for Emergency Medicine Physician near BROOKHAVEN, MS! Join Our Dedicated Team! Shape the Future of Emergency Medicine in a Dynamic Setting! Position Overview: Are you a dynamic and dedicated Emergency Medicine Physician seeking a rewarding career opportunity? Look no further! We are actively recruiting a Physician to join...

  • Physician - Emergency Medicine Job in Mississippi

    4 weeks ago

    Brookhaven, United States Hayman Daugherty Associates, Inc Full time

    Job Overview Exciting Opportunity for Emergency Medicine Physician near BROOKHAVEN, MS! Join Our Dedicated Team! Shape the Future of Emergency Medicine in a Dynamic Setting! Position Overview: Are you a dynamic and dedicated Emergency Medicine Physician seeking a rewarding career opportunity? Look no further! We are actively recruiting a Physician to join...