RN Utilization Manager - (Per Diem) Care Management

UNC Health Care; Smithfield (NC); On-site; USD 49,000 - 71,000; Full time

Job summary

UNC Health Care is seeking a Utilization Manager in Smithfield, NC, to collaborate with an interdisciplinary team and manage patient care progression from admission to discharge. The role emphasizes adherence to utilization management plans, documentation, and coordination with payors.

Per diem, onsite daytime schedule with state licensure required. Requirements include RN licensure in North Carolina, 2 years of clinical or utilization management experience, and a Nursing degree.

Qualifications

• Licensed to practice as a Registered Nurse in the state of North Carolina.
• Two (2) years of clinical experience in a medical facility and/or comparable Utilization Management experience.

Responsibilities

• Clinical Review Process - review admissions and status changes within 24 hours, coordinate with care teams and payors.
• Discharge Facilitation - identify complex discharge planning needs and initiate social work referrals.
• Utilization Management Process - perform assessments and interventions to ensure appropriate setting and efficient care.
• Utilization Outcomes Management - monitor documentation quality and assist in coding accuracy; coordinate between patients, families and payors.

Skills

RN licensure NC

Education

Bachelor's degree in Nursing

Master's degree in Nursing

Job description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary

Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This may include delivering notifications to patients directly. Interface is completed verbally, via email, data base tasks, or other electronic communication and via telephone.

Responsibilities

1. Clinical Review Process - Uses approved criteria and conducts admission review/status change review within 24 hours of patient admission to the hospital to ensure appropriateness of the setting and timely implementation of the plan of care. Identifies and obtains observation status as appropriate. Partners with physicians, nursing, and other care providers to help ensure timely and accurate documentation of patient data and treatments. Communicates daily with the Case Manager to manage level of care transitions & appropriate utilization of services. Coordinates with the support center to assure third party payor pre-certification and/or re-certifications when required. Utilizes high risk screening criteria to make appropriate referrals to Manager.

2. Discharge Facilitation - Identifies patient/families with the complex psychosocial, on-going medical discharge planning issues, continuing care needs by initiating appropriate case management referrals. Initiates appropriate social work referrals.

3. Utilization Management Process - Performs utilization management assessments and interventions, using collaboration with interdisciplinary team approach, on assigned patients as appropriate to ensure optimal patient outcomes. Using approved criteria, conducts continued stay and quality reviews to monitor the patient's progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective. Enters all pertinent review data into the correct computer system in a timely manner. Consults with Physician Advisor as necessary to resolve barriers through appropriate administrative and medical channels.

4. Utilization Outcomes Management - Monitors and guides to trend interdisciplinary documentation and guides medical staff in documentation that will assist in coding accuracy, enhance quality of care, reflect accurate severity of illness and appropriate reimbursement. Facilitates patient movement to appropriate (acuity) level of care including observation status issues through collaboration with patient/family, multidisciplinary team, third party payors and resource center. Provides information regarding denials and approvals to designated entities. Assists in coordination of practice parameter development with the assigned departments/sections/specialties of Medical Staff. Oversees collection and analysis of patient care and financial data relevant to the target case types. Directs delivery of notifications to patients (includes traveling to hospital(s) to deliver notifications.

Other Information

Other information:

Education Requirements

• Graduation from a state-accredited school of professional nursing
• If hired after October 1, 2015, must be enrolled in an accredited program within four years of employment, and obtain a Bachelor's degree with a major in Nursing or a Master's degree with a major in Nursing within seven years of employment date.

Licensure/Certification Requirements

• Licensed to practice as a Registered Nurse in the state of North Carolina.

Professional Experience Requirements

• Two (2) years of clinical experience in a medical facility and/or comparable Utilization Management experience.

Knowledge/Skills/and Abilities Requirements

Job Details

Legal Employer: NCHEALTH

Entity: Johnston Health

Organization Unit: Care Management -

Work Type: Per Diem

Standard Hours Per Week: 4.00

Salary Range: $35.87 - $51.57 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: US:NC:Smithfield

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [e-mail] if you need a reasonable accommodation to search and/or to apply for a career opportunity.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.