UR Specialist- Care Management (Remote)

Phoebe Putney Health System•Remote - Georgia, GA

3d•Remote

About The Position

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 complext 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 managment functions and meeting patient needs. Will notifiy Care Managers of potential denials and communicate with patient physician and payer medical director for peer to peer discussions.

Requirements

2 year / Associate Degree in Nursing (Required)
Registered Nurse (RN) with current Georgia license
4 - 5 years Recent and relevant acute clinical care experience (Required)
1 - 2 years Utilization review experience in a hospital, managed care or physician office practice setting. (Required)
Proficient computer typing skills, use of electronic health record and internet.
Able 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
Near normal vision - Clarity of vision (both near and far), ability to distinguish colors
Good manual dexterity and eye-hand-foot coordination

Nice To Haves

4 year / Bachelor's Degree in Nursing (Preferred)
CCM or CPUR (Preferred Certifications/Licensures)

Responsibilities

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 to insurance companies.
Liaising with third party payers regarding UR requirements, authorization or denial matters.
Assisting with complex authorization needs impacting patient transition planning.
Proactive communication with Care Manager and Social Work staff.
Notifying Care Managers of potential denials.
Communicating with patient physician and payer medical director for peer to peer discussions.