Utilization Review Nurse Coordinator (RN)-Atrium Health- Remote-PT Days
About the position The Utilization Review Nurse Coordinator (RN) is responsible for identifying the clinical, financial, and psychosocial needs of patients and families. This role provides leadership and guidance to a multidisciplinary team to develop an individualized plan of care. The coordinator ensures essential information and necessary forms are placed in the revenue cycle tool and available for the revenue cycle team and other disciplines. They also provide necessary documentation and information to third-party administrators as needed, perform admission and concurrent reviews, and apply clinical guidelines during these reviews to identify potential third-party denials. The role involves working with the multidisciplinary team to identify and implement alternative plans of care, initiating and requesting authorizations for post-acute care, and referring pertinent cases to the Medical Director, Service Director, and/or Physician Advisor. Collaboration with physicians to plan and implement medical and multidisciplinary plans of care, utilizing clinical pathways, is also a key function. The coordinator identifies and escalates barriers and problems to the multidisciplinary team and leadership for intervention and resolution, and develops and maintains accurate case records, documenting in the patient's medical record according to department and facility standards.
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.
- Ensures essential information and necessary forms are placed in the revenue cycle tool and available for the revenue cycle team and other disciplines.
- Provides necessary documentation and information to third party administrators as needed.
- 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.
- Initiates and request authorizations for post-acute care as needed to facilitate care coordination.
- Refers pertinent cases to the Medical Director, Service Director, and/or Physician Advisor in a timely manner.
- Collaborates as needed with the physician to plan and implement medical and multidisciplinary plan(s) of care, utilizing clinical pathways when appropriate and available.
- Identify and escalate barriers and problems to the multidisciplinary team and leadership for intervention and resolution.
- Develops and maintains accurate case records of assigned cases.
- Documents in the patient's medical record according to department and facility standards.
Requirements
- Graduation from an accredited School of Nursing required.
- Applicable state RN licensure required.
- Basic Life Support (BLS) for Healthcare Provider (HCP) per facility requirements.
Nice-to-haves
- Bachelor's degree in nursing preferred.
- Related experience preferred.
- Prior utilization management and behavioral health experience preferred.
Benefits
- Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
- 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