RN Utilization Manager

4 weeks ago


Smithfield, Utah, United States UNC Health Care Full time

Job Summary:

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Key Responsibilities:

  • Collaborate with the patient/family, and interdisciplinary team to assess the patient care progression from acute care episode through post-discharge for quality, efficiency, and effectiveness.
  • Work collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum.
  • Complete admission, continued stay, and discharge reviews in accordance with federal regulations and the Hospitals' Utilization Management Plan.
  • Reconcile physician orders, bed billing type, and medical necessity to ensure revenue protection.

Additional Responsibilities:

  • Conduct clinical review processes using approved criteria and identify observation status as appropriate.
  • 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 assure third-party payor pre-certification and/or re-certifications when required.

Requirements:

  • Graduation from a state-accredited school of professional nursing.
  • Licensed to practice as a Registered Nurse in the state of North Carolina.
  • Two years of clinical experience in a medical facility and/or comparable Utilization Management experience.

Work Environment:

This position is employed by UNC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System.

This is not a State employed position.



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