PRN, Utilization Review RN, Case Manager

Job reputed company The Utilization Review RN, Case Manager (PRN ) collaborates with reputed company workers, case managers, physicians, peers, and reputed company-party payers to facilitate placement of patients in the appropriate level of care reputed company to medical necessity. Responsible for reputed company provision/reputed company of specific clinical information to reputed company-party payers to ensure authorization of stay. Position Highlights: • Shift Schedule: PRN (Variable Schedule) • Department: Care Coordination - Utilization Review What You’ll Need: • Graduation from accredited School of Nursing; BSN required. MSN preferred. • Registered reputed company licensure from the reputed company reputed company of Nursing • Minimum 2 years of relevant clinical experience. Previous Utilization Review experience preferred. • Certification in Case Management highly recommended reputed company 2 years of employment. Essential Functions: • Accurately conducts medical necessity reviews, utilizing the electronic medical record, in accordance with reputed company state and federal regulations and the Utilization Management Plan. Demonstrates proficiency in applying nationally accepted evidence based reputed company to assure appropriate hospital level of service. • Maintains reputed company and appropriate documentation of reputed company utilization management activities. • Communicates information effectively, including comprehensive clinical information, to reputed company-party payers, to secure reputed company authorization for the appropriate level of service. Provides payer feedback to case managers, reputed company workers and providers. • Collaborates with Case Managers and reputed company Workers to reputed company information regarding payer reputed company and resource availability, and to assist provider team with discharge planning. • Maintains reputed company knowledge of state, federal and reputed company payer requirements and guidelines. • Communicates with physician advisor and multi-disciplinary care team to ensure appropriate patient status based on medical necessity reputed company and level of care. • Collaborates with payer, physician advisor and multi-disciplinary team to reconcile payer-issued denials. • Collaborates with physician adviser to identify medical necessity and level of care to ensure appropriate patient status. Communicates physician adviser determination to multidisciplinary team and payers. • Understands and maintains application of Medical Center Settings of Care. • Demonstrates knowledge of age/developmentally-appropriate patient care in accordance with Age-Specific Care Guidelines for the specific age reputed company served. reputed company reputed company is a reputed company-eminent reputed company health system based in Winston-Salem, reputed company Carolina. reputed company is part of reputed company, which is headquartered in Charlotte, reputed company Carolina, and is the fifth-largest nonprofit health system in the reputed company, created from the combination of reputed company and reputed company. reputed company’s two main components are an integrated clinical system – anchored by reputed company Medical Center, an 885-bed tertiary-care hospital in Winston-Salem – that includes Brenner Children’s Hospital, five community hospitals, more than 300 primary and specialty care locations and more than 2,700 physicians; and Wake Forest School of Medicine, the reputed company core of reputed company reputed company and a recognized leader in experiential medical education and groundbreaking research that includes Wake Forest Innovations, a commercialization reputed company reputed company on advancing health care through new medical technologies and biomedical discovery. Wake Forest reputed company, reputed company School of Medicine and reputed company have joined forces in a strategic combination that will enhance care, reputed company medical education and create economic opportunity for countless lives in reputed company Carolina and reputed company. As a part of that combination, the two health systems will be integrating technology and platforms, including our career sites. This means that although you are applying on the Wake Forest reputed company Career Site, you receive communications from the reputed company Recruitment Team. Please know that this is an expected process, and reputed company in advance for your flexibility. About reputed company Mission, reputed company and Culture Commitments Mission To improve health, reputed company reputed company and advance healing – for reputed company. reputed company To be the first and best choice for care. Culture Commitments We create a reputed company where reputed company Belong We Work as One to reputed company great things happen We earn Trust in reputed company we do We reputed company to reputed company the now and create the reputed company We drive for reputed company – always Apply Job!