RN Coordinator - Utilization Review Behavioral Health Remote (NC,SC) PRN Days
About The Position
Identifies clinical, financial, and psychosocial needs of patients/families and provides leadership and guidance to the multidisciplinary team to develop an individualized plan of care. Ensures essential information and necessary forms are placed in the revenue cycle tool and available for the revenue cycle team and other disciplines. Provides necessary documentation and information to third party administrators as needed. Performs admission and concurrent reviews. Applies clinical guidelines during Admission and Concurrent reviews and identifies potential third-party denials. Works with multidisciplinary team to identify and implement alternative plans of care. Initiates and request authorizations for post-acute care as needed to facilitate care coordination. Refers pertinent cases to the Medical Director, Service Director, and/or Physician Advisor in a timely manner. Collaborates as needed with the physician to plan and implement medical and multidisciplinary plan(s) of care, utilizing clinical pathways when appropriate and available. Identify and escalate barriers and problems to the multidisciplinary team and leadership for intervention and resolution. Develops and maintains accurate case records of assigned cases. Documents in the patient's medical record according to department and facility standards.
Requirements
- Graduation from an accredited School of Nursing required.
- Bachelor's degree in nursing preferred.
- applicable state RN licensure required.
- Related experience preferred
- Basic Life Support (BLS) for Healthcare Provider (HCP) per facility requirements
Nice To Haves
- Bachelor's degree in nursing preferred.
- Related experience preferred
Responsibilities
- Identifies clinical, financial, and psychosocial needs of patients/families and provides leadership and guidance to the multidisciplinary team to develop an individualized plan of care.
- Ensures essential information and necessary forms are placed in the revenue cycle tool and available for the revenue cycle team and other disciplines.
- Provides necessary documentation and information to third party administrators as needed.
- Performs admission and concurrent reviews.
- Applies clinical guidelines during Admission and Concurrent reviews and identifies potential third-party denials. Works with multidisciplinary team to identify and implement alternative plans of care.
- Initiates and request authorizations for post-acute care as needed to facilitate care coordination.
- Refers pertinent cases to the Medical Director, Service Director, and/or Physician Advisor in a timely manner.
- Collaborates as needed with the physician to plan and implement medical and multidisciplinary plan(s) of care, utilizing clinical pathways when appropriate and available.
- Identify and escalate barriers and problems to the multidisciplinary team and leadership for intervention and resolution.
- Develops and maintains accurate case records of assigned cases. Documents in the patient's medical record according to department and facility standards.
Benefits
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
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What This Job Offers
Job Type
Part-time
Industry
Hospitals
Number of Employees
5,001-10,000 employees
