Registered Nurse (RN) – Utilization Review – PRN Days

Live Well Homecare Agency, LLC; Austell (GA); Presencial; USD 65.000 - 90.000; A tiempo parcial

Descripción de la vacante

Live Well Homecare Agency, LLC in Austell, GA is seeking an Utilization Management Nurse (UM) Coordinator to conduct 24/7 medical necessity reviews, determine appropriate levels of care, and coordinate with payers, providers, and care teams to obtain authorizations and monitor patient progress.

The role emphasizes meticulous documentation, compliance with payer and regulatory requirements, patient advocacy, and ongoing professional development within an integrated health system.

Formación

• Minimum 3 years of clinical practice.
• Associates or Bachelor’s Nursing degree preferred; RN license (state or multi-state) and BLS certification required.
• Strong knowledge of case management and excellent communication, organizational, and critical thinking skills.

Responsabilidades

• Perform daily clinical reviews of admissions, observation cases, and concurrent care using established criteria.
• Obtain timely authorizations, document activities accurately, and communicate with payers to resolve discrepancies.
• Monitor post-discharge accounts for authorization issues, variances, and denials, escalating as needed.
• Ensure compliance with payer and regulatory requirements, advocate for patients, and support continuous improvement initiatives.
• Complete thorough documentation and participate in professional development activities.

Conocimientos

Clinical experience

Case management knowledge

Communication skills

Organizational skills

Critical thinking

Educación

RN license (state or multi-state)

BLS certification

Herramientas

Computer proficiency

Descripción del empleo

Role Overview: The Utilization Management Nurse (UM) Coordinator conducts 24/7 medical necessity reviews, utilizing clinical guidelines and documentation to determine appropriate levels of care. They communicate with payers, providers, and care teams to obtain authorizations, monitor patient progress, and facilitate safe care transitions.

Key Responsibilities:

• Perform daily clinical reviews of admissions, observation cases, and concurrent care using established criteria.
• Obtain timely authorizations, document activities accurately, and communicate with payers to resolve discrepancies.
• Monitor post-discharge accounts for authorization issues, variances, and denials, escalating as needed.
• Ensure compliance with payer and regulatory requirements, advocate for patients, and support continuous improvement initiatives.
• Complete thorough documentation and participate in professional development activities.

Qualifications & Skills:

• Minimum 3 years of clinical practice with strong clinical knowledge.
• Associates or Bachelor’s Nursing degree preferred; RN license (single or multi-state), BLS certification required.
• Knowledge of case management, excellent communication, organizational, and critical thinking skills.
• Proficient in screening criteria, clinical data review, and computer use.

Additional Details:

The role involves working PRN days, with responsibilities including assessments, documentation, collaboration with healthcare providers, and ensuring compliance with regulations. The position offers an opportunity to contribute to patient care quality while developing professionally within an integrated health system.