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RN Medical Care Specialist PRN
2 months ago
We are seeking a skilled RN Medical Care Specialist PRN to join our team at Children's Healthcare of Atlanta. As a key member of our utilization review team, you will play a critical role in ensuring the highest quality of care for our patients.
Key Responsibilities- Evaluate patients 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.
- Initiate and facilitate 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.
- Supports organizational efforts to ensure accurate capture of admission status and level of care using Epic and escalating cases for status change where necessary.
- 3 years of RN experience in a healthcare setting
- Bachelor of Science in Nursing
- ~ 2 years of experience in hospital or insurance related utilization review
- Graduation from an accredited school of nursing
- Working knowledge of financial aspects of third-party payors and reimbursement
- 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
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.
