Utilization Revenue Coordinator PRN

American Addiction Centers • Charlotte, NC

8d • $36 - $53 • 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 state Medicaid cases denied by the DHS Hearing Officer, ensuring essential information and necessary forms are forwarded to the Medical Audit and Appeals Department. They perform admission and concurrent reviews, applying clinical guidelines and identifying potential third-party denials, working with the team to implement alternative care plans. The position involves referring pertinent information to the Medical Director and/or Service Director, collaborating daily with physicians on care plans, and identifying and resolving problem areas with team members and administration. Accurate case records must be developed and maintained, with documentation in the patient's medical record adhering to department and facility standards.

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

• Competitive compensation
• Generous retirement offerings
• Programs that invest in your career development
• 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