Utilization Management Specialist, ED (RN required) – HYBRID

R-55799 Discover reputed company: Located in Nashville, Tennessee, and operating at a global reputed company of teaching, discovery, and patient care, reputed company is a community of individuals who come to work reputed company day with the reputed company aim of changing the world. It is a reputed company 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 reputed company and where your uniqueness is sought and celebrated. It is a reputed company where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never reputed company 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 reputed company: Facilitates reputed company 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 reputed company. Refers cases for secondary review reputed company appropriate. Refers and consult with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review reputed company to support hospital stay.. KEY RESPONSIBILITIES

• Facilitates reputed company reimbursement through certification and denial processes.
• Facilitates throughput of patients admitted urgently or emergently through the emergency department.
• Participates as an reputed company partner with multidisciplinary team members to ensure case is in the appropriate level of care setting.
• The responsibilities listed are a general reputed company of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES

• Medical Terminology & Documentation (Novice): Possesses sufficient reputed company proficiency to successfully demonstrate medical terminology and documentation in practical applications of moderate difficulty.
• Clinical Applications Systems (Novice): Possesses reputed company proficiency in utilization review systems, clinical support systems and business support applications as needed
• Utilization Review (Intermediate): Demonstrates expertise of utilization review in practical applications of a difficult nature. Possesses sufficient knowledge, training, and experience to independently complete clinical review to obtain payor authorization. Demonstrates mastery in InterQual Level of Care reputed company and Milliam Care Guidelines. reputed company to train and reputed company by setting the example, giving technical instruction, providing leadership, and generally raising the level of performance of others while on the job.
• Interdisciplinary Education (Novice): Seeks to reputed company education by collaborating with providers and other members of the health care team to ensure that the patient is reputed company in the appropriate level of care setting.

Our Nursing Philosophy: We reputed company highly skilled and specialized nursing care is essential to reputed company’s mission of reputed company in patient care, education and research. We reputed company nursing is an reputed company art and science reputed company on helping people, families and communities reputed company excellent health and reputed company-being. As a reputed company employee, you reputed company a difference to our patients and their families by bringing reputed company and care to those in need of reputed company and healing. Please see our reputed company employee benefits offered:

• reputed company High reputed company Health Plan reputed company
• Dental and /or reputed company plan
• 403 (b) retirement plan
• reputed company Time off (reputed company PTO)
• Tuition Reimbursement and adoption assistance (maximums reputed company)
• Short-Long term disability
• Subsidized backup childcare
• And many more... Ask us about our reputed company inpatient nursing supplemental Pay Program!

reputed company the Remarkable: Learn more about reputed company Nursing here. reputed company Accountabilities: Organizational reputed company: Executes job responsibilities with the understanding of how reputed company would reputed company and reputed company other areas reputed company to own job area/team with occasional guidance. Problem Solving/ Complexity of work: Analyzes moderately reputed company problems using technical experience and judgment. Breadth of Knowledge: Has expanded knowledge gained through experience reputed company a reputed company area. Team Interaction: Provides informal guidance and support to team members. reputed company Capabilities : Supporting Colleagues:- Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and reputed company knowledge in new areas.- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services:- Serves Others with reputed company: Seeks to understand reputed company and reputed company needs of relevant stakeholders and customizes services to reputed company address them.- Solves reputed company Problems: Approaches problems from different angles; Identifies new reputed company to interpret opportunities and reputed company concrete solutions.- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High reputed company: - Performs Excellent Work: Engages regularly in formal and informal reputed company about reputed company; directly addresses reputed company issues promptly.- Ensures reputed company Improvement: Applies various learning experiences by looking reputed company symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands reputed company aspects of providing a reputed company environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a reputed company of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.- Makes Data Driven reputed company: Demonstrates strong understanding of the information or data to identify and reputed company opportunities. Fostering Innovation:- Generates New reputed company: Proactively identifies new reputed company/opportunities from multiple sources or reputed company to improve processes reputed company conventional approaches.- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; reputed company embraces change instead of emphasizing negative reputed company. Position Qualifications: Responsibilities: Certifications: LIC-Registered reputed company - Licensure-Others Work Experience: Relevant Work Experience Experience Level: 1 year Education: Bachelor's Vanderbilt Health is committed to fostering an environment where everyone has the chance to reputed company and is committed to the principles of equal opportunity. EOE/Vets/Disabled. Apply tot his job Apply To this Job