Utilization Management Specialist, ED (RN required) - HYBRID

Vanderbilt University Medical Center•Nashville, TN

2d•Hybrid

About The Position

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: Utilization Management 20 Job Summary: Facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when appropriate. Refers and consult with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review criteria to support hospital stay. . KEY 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.

Requirements

LIC-Registered Nurse - Licensure-Others
Relevant Work Experience Experience Level: 1 year
Bachelor's

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.