Pediatric Utilization Management RN Coordinator

Dolly Parton Children's Hospital

Knoxville (TN)

Hybrid

USD 60,000 - 80,000

Full time

11 days ago

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Job summary

Dolly Parton Children's Hospital is seeking an Utilization Management Coord to perform pre-certification and extended stay reviews for inpatients and observation patients. This hybrid role in Knoxville, TN, reports to the Director of Health Information Management.

Ideal candidates hold RN and/or RHIA credentials with 2+ years in utilization review. Responsibilities include communicating with insurers, entering data into Meditech, and supporting discharge planning.

Qualifications

Knowledge of medical terminology, anatomy & physiology.
Pediatric nursing experience.
Excellent communication skills.
Detail-oriented with strong organizational skills.
Proficient in computers and office software.
Familiarity with reference materials and resources.

Responsibilities

Obtains initial pre-certification review for admissions through the emergency room.
Notifies insurance companies of patient admissions and submits clinical information per policy.
Verifies/obtains pre-certification for admissions from physician offices; performs extended stay reviews.
Enters precertification numbers and days into Meditech; updates dates for next clinical update.
Maintains records (paper and electronic) for utilization review.
Participates in discharge planning and Utilization Management Committee activities.
Processes appeals (concurrent, retrospective, second level) and assists outside reviewers.
Provides training to new utilization management coordinators on Meditech and related tools.