Utilization Management Specialist: Reimbursement & Care

Vanderbilt Health; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health Plan Options

Dental/Vision Plan

403(b) Retirement Plan

Paid Time Off

Tuition Reimbursement

Disability Insurance

Backup Childcare

Inpatient Nursing Supplemental Pay

Job summary

Vanderbilt University Medical Center seeks an experienced utilization management professional to facilitate optimal reimbursement through certification and thorough chart documentation, ensuring appropriate admission status and timely patient care decisions.

The role collaborates with the multidisciplinary team to determine the appropriate level of care and supports throughput for urgent or emergent admissions.

Qualifications

• 1 year of relevant work experience in healthcare.
• Nursing licensure in good standing (RN) preferred.
• Familiarity with utilization management and patient care pathways.

Responsibilities

• Facilitates optimal reimbursement through certification and denial processes.
• Facilitates throughput of patients admitted urgently or emergently through the emergency department.
• Participates as an active partner with multidisciplinary team members to ensure case is in the appropriate level of care setting.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

Skills

Medical Terminology & Documentation

Utilization Review

Interdisciplinary Education

Clinical Applications Systems

Education

Bachelor's

Job description

Vanderbilt University Medical Center seeks an experienced utilization management professional to facilitate optimal reimbursement through certification and thorough chart documentation, ensuring appropriate admission status and timely patient care decisions.

The role collaborates with the multidisciplinary team to determine the appropriate level of care and supports throughput for urgent or emergent admissions.