Utilization Review Registered Nurse, PRN

Trinity Health; Athens (GA); On-site; USD 40,000 - 64,000; Part time

Job summary

Trinity Health in Athens, GA is seeking a part-time Utilization Review Coordinator to collaborate with a multidisciplinary team and ensure appropriate care levels across the hospital stay.

The role involves conducting clinical reviews using medical necessity criteria and acting as a liaison with external payers to address authorization requirements and timely utilization of services.

Responsibilities

• Collaborates with physicians, nurses, patient access, billing personnel, and external payers to ensure appropriate level of care throughout the continuum of care.
• Conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and appropriate resource utilization during hospitalization.
• Serves as a liaison between Trinity Health and external payers regarding medical necessity, severity of illness, intensity of service, authorization requirements, and timely utilization of hospital services.

Job description

Employment Type:

Part time

Shift:

Description:

The Utilization Review (UR) Coordinator collaborates with a multidisciplinary team, including physicians, nurses, patient access staff, billing personnel, and external payers, to ensure patients receive the appropriate level of care throughout the continuum of care in an efficient, cost-effective, and quality-focused manner. The UR Coordinator conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and appropriate resource utilization throughout hospitalization. This role serves as a liaison between the hospital and external payers regarding medical necessity, severity of illness, intensity of service, authorization requirements, and timely utilization of hospital services.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran