UR Specialist- Care Management (Remote)

Phoebe Putney Health System; Albany (GA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking an UR Specialist for Care Management, responsible for managing authorization reviews and liaising with third-party payers. The ideal candidate must be a registered nurse with experience in utilization review, dedicated to optimizing patient care and compliance with regulations.

Qualifications

• Registered Nurse (RN) with current Georgia license required.
• 4-5 years of recent acute clinical care experience needed.
• 1-2 years of utilization review experience in healthcare preferred.

Responsibilities

• Perform activities related to insurance notifications and certifications.
• Communicate clinical information to insurance companies.
• Liaise with payers regarding UR requirements and patient transitions.

Skills

Interpersonal skills

Customer relations

Analytical skills

Communication skills

Proficient computer typing

Organizational skills

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Office Suite

Electronic health record

Job description

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Join to apply for the UR Specialist- Care Management (Remote) role at Phoebe Putney Health System

The primary responsibilities of the RN UR Specialist include performing activities related to insurance company notifications, obtaining certifications and authorizations related to Utilization review duties in Care Management. Timely communication of clinical information and updates will be provided to the insurance companies as requested or required by contract or federal and state regulations in support of medical necessity justification and hospital billing and payment for patient care and services rendered. He/she will liaison with third party payers regarding UR requirements, authorization or denial matters, and will assist with complex authorization needs impacting patient transition planning. Proactive communication with Care Manager and Social Work staff will foster coordination and a team approach for key care management functions and meeting patient needs. Will notify Care Managers of potential denials and communicate with patient physician and payer medical director for peer to peer discussions. Adheres to the hospital and departmental attendance and punctuality guidelines. Performs all job responsibilities in alignment with the core values, mission and vision of the organization. Performs other duties as required and completes all job functions as per departmental policies and procedures. Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs). Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time. Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs. For non-clinical areas, has attended training and demonstrates usage of age-specific customer service skills. Works in a well-lighted, air-conditioned area, with moderate noise levels. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids, or infectious organisms. May be required to change from one task to another of different nature without loss of efficiency or composure. Periods of high stress and fluctuating workloads may occur. May be scheduled as needed including overtime. Education requirements include 2 year / Associate Degree in Nursing (Required) and 4 year / Bachelor's Degree in Nursing (Preferred). Experience requirements include 4 - 5 years recent and relevant acute clinical care experience (Required) and 1 - 2 years Utilization review experience in a hospital, managed care or physician office practice setting (Required). Required Certifications/Licensures: Registered Nurse (RN) with current Georgia license. Preferred Certifications/Licensures: CCM or CPUR. General skills include interpersonal skills, customer relations, mathematical, analytical, grammar/spelling, reading/comprehending written instructions, following verbal instructions, transcription, Microsoft Office Suite, general clerical skills, proficient computer typing skills, use of electronic health record and internet, ability to generate basic spreadsheets and word documents, highly organized and detail oriented with ability to meet tight timeframes and time sensitive actions, effective verbal and written communication skills. Physical requirements include near normal vision, good manual dexterity and eye-hand-foot coordination. Physical demands include frequent standing, walking, sitting, bending/stooping, twisting at waist, pushing/pulling, reaching above shoulder, lifting/carrying up to 20 lbs frequently, occasional climbing and lifting/carrying > 20 lbs with assistance. Phoebe Putney Health System employees are prohibited from working as Remote employees in certain states listed.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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