RN Utilization Management Coordinator PRN
RN Utilization Management Coordinator PRN
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
- Participates within the department to meet expected objectives and outcomes.
- Meets or exceeds expectations related to behavior and performance. Meets individual and departmental objectives established for Quality Satisfaction Growth and Financial Success.
- Conducts timely and accurate utilization reviews as assigned using organization-approved UR criteria.
- Works closely with physician advisors and medical staff to ensure appropriate level of care including obtaining physician orders for patient class changes when needed.
- Refers cases as defined for 2nd level medical necessity review.
- Maintains daily contact with payers to obtain authorization and reauthorization information and addresses concurrent denials and/or audit requests.
- Provides UR and clinical documentation is adequate and complies with payer requirements.
- Schedules next review/follow-up reviews as required in accordance with organizational policy and procedure and payer requests.
- Routinely collaborates with the System Clinical Appeals and Revenue Cycle departments to expedite billing and appeals processes.
- Maintains and monitors assigned work queues within the Electronic Medical Record.
- Required Associates Degree Associates or technical degree.
- Preferred Bachelors Degree in nursing or related field.
- Hospital utilization review/utilization management experience. Preferred
- Clinical appeals experience. Preferred
- 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
- Registered Nurse (RN) - State of Michigan Upon Hire required
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Beaumont Service Center - 26901 Beaumont BlvdDepartment Name
Utilization Management - CH EastEmployment Type
Part timeShift
Day (United States of America)Weekly Scheduled Hours
0.04Hours of Work
8:00 A.M. to 4:30 P.M.Days Worked
VariableWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
IC
Employment Type
Part-Time
