RN Utilization Manager

1 month ago


Chapel Hill, North Carolina, United States UNC Health Full time
Job Summary

We are seeking a highly skilled and experienced RN Utilization Manager to join our team at UNC Health. As a key member of our clinical care management team, you will play a critical role in ensuring the quality, efficiency, and effectiveness of patient care.

Responsibilities
  • Conduct admission reviews and continued stay reviews to ensure appropriateness of patient care and timely implementation of the plan of care.
  • Partner with physicians, nursing, and other care providers to ensure timely and accurate documentation of patient data and treatments.
  • Communicate daily with the Case Manager to manage level of care transitions and appropriate utilization of services.
  • Coordinate with the support center to ensure third-party payor pre-certification and/or re-certifications when required.
  • Utilize high-risk screening criteria to make appropriate referrals to the Manager.
  • Identify patient/families with complex psychosocial, on-going medical discharge planning issues, continuing care needs by initiating appropriate case management referrals.
  • Initiate appropriate social work referrals.
  • Perform utilization management assessments and interventions using a collaboration with interdisciplinary team approach to ensure optimal patient outcomes.
  • Conduct continued stay and quality reviews to monitor the patient's progress along the continuum of care and intervene as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective.
  • Enter all pertinent review data into the correct computer system in a timely manner.
  • Consult with Physician Advisor as necessary to resolve barriers through appropriate administrative and medical channels.
Requirements
  • Graduation from a state-accredited school of professional nursing.
  • Two (2) years of clinical experience in a medical facility and/or comparable Utilization Management experience.
  • Licensed to practice as a Registered Nurse in the state of North Carolina.
Work Environment

This is a full-time position with a standard 40-hour workweek. The work schedule is day shift, with flexible schedule options available. The location of the job is UNC Medical Center in Chapel Hill, NC.



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