Utilization Management Nurse: Care Coordination

126 Atrium Health Hospitals, Inc.; Shelby (NC); On-site; USD 4,890,000 - 7,336,000; Part time

Benefits offered by this job

Health and welfare benefits

Paid Time Off

Educational Assistance Program

Retirement plans with employer match

Shift differentials

Job summary

Advocate Health is seeking a part-time Case Management professional in Shelby, NC, for a 24-hour workweek. The role focuses on coordinating care, utilization management, and compliance with CMS and state regulations.

A BSN and RN license are required, with preferred master’s in healthcare or business and 5 years of nursing experience. Responsibilities include collaboration with the care team, payors, and providers to ensure timely authorization and appropriate level of care, while maintaining

Qualifications

• Bachelor's in Nursing from an accredited school, required.
• Master's degree in business or healthcare related field, preferred.
• Current RN license in the state you practice and reside or valid NP license as applicable.
• 5 years of related nursing experience preferred.

Responsibilities

• Coordinate with healthcare team and payors to facilitate placement based on medical necessity.
• Promote open communication between utilization management and healthcare team.
• Provide timely clinical information to third-party payors to ensure authorization stay.
• Ensure compliance with CMS, state and federal regulatory requirements.
• Perform admission and continued stay utilization reviews for medical necessity and level of care.
• Demonstrate proficiency with evidence-based criteria to assure appropriate hospital level of service.
• Maintain timely documentation of utilization management activities.
• Escalate and resolve denials to secure payment for necessary care.
• Collaborate with payors, physicians, and care team to reconcile denials.

Skills

Analytical skills

Financial analysis

Utilization review

Communication with payors

Education

Bachelor's in Nursing

Master's degree in healthcare or business

RN license current

5 years nursing experience preferred

Job description

Advocate Health is seeking a part-time Case Management professional in Shelby, NC, for a 24-hour workweek. The role focuses on coordinating care, utilization management, and compliance with CMS and state regulations.

A BSN and RN license are required, with preferred master’s in healthcare or business and 5 years of nursing experience. Responsibilities include collaboration with the care team, payors, and providers to ensure timely authorization and appropriate level of care, while maintaining