Utilization Revenue Coordinator PRN

Advocate Health and Hospitals Corporation • Charlotte, NC

15h • Onsite

About The Position

The Utilization Revenue Coordinator PRN is responsible for identifying the clinical, financial, and psychosocial needs of patients and their families. This role provides leadership and guidance to the multidisciplinary team to develop an individualized plan of care. The coordinator also handles appeals for denied state Medicaid cases, ensures essential information is forwarded to the Medical Audit and Appeals Department, and performs admission and concurrent reviews using clinical guidelines to identify potential third-party denials. They collaborate with the multidisciplinary team, physician, and administration to plan and implement care, identify problem areas, and implement resolutions. Accurate case record development and documentation in the patient's medical record according to department and facility standards are also key responsibilities.

Requirements

• Graduation from an accredited School of Nursing.
• Applicable state RN licensure required.
• Basic Life Support for Healthcare Provider (BLS HCP) from AHA required.

Nice To Haves

• 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.
• Coordinates appeals when applicable state Medicaid cases are denied with the DHS Hearing Officer.
• Ensures that essential information and necessary forms are forwarded to the Medical Audit and Appeals Department.
• 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.
• Refers pertinent information to the Medical Director, and/or Service Director in a timely manner.
• Collaborates on a daily basis with the physician to plan and implement the medical and multidisciplinary plan of care, utilizing clinical pathways when appropriate and available.
• Works with team members and administration to identify problem areas and implement resolutions.
• 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

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level