MariettaRecruiter Since 2001
the smart solution for Marietta jobs

Registered Nurse, Central Utilization Management

Company: WellStar Health System
Location: Marietta
Posted on: January 9, 2021

Job Description:

At WellStar, we all share common goals. That---s what makes us so successful --- and such an integral part of our communities. We want the same things, for our organization, for our patients, and for our colleagues. As the--most integrated healthcare provider--in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare. Responsibilities The Utilization Management Nurse (UM) Coordinator is responsible for conducting medical necessity reviews 24 hours per day, 7 days per week. utilizing Millman Care Guidelines, l clinical reviews with payers and collaborating with the care team on the coordination of safe transitions of care for a defined patient population. The Utilization Management Nurse will perform utilization review every day by looking at all new admissions, all observation cases and concurrent reviews. They will be assigned to specific units/and or payer/and or patient class. All clinical reviews will be done by utilizing Milliman criteria in conjunction with medical records documentation communication with physicians and physician---s advisors.The UM nurse will gather clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to complete the determination/recommendation for the most appropriate level of care status and clinical review to the payers. Along the continuum of care, communicates with providers and other parties to facilitate care/treatment. Identifies members for referral/consult opportunities to streamline care and throughput ensuring delays are avoided. identifies opportunities to ensure effectiveness of healthcare services in the most appropriate setting always as well as timely discharge to the most appropriate level of post discharge care.Utilization Management Nurse will obtain timely authorization of all ALOS days from payers and ensure this is documented in the appropriate place in EPIC to enable timely billing. Will monitor post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that require clinical expertise. The UM Nurse will communicate with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. Escalate medical review request and/or denial activities to management as needed UM Nurse will work post discharge, prebill accounts efficiently and effectively daily to resolve accounts with ---no auth numbers, ALOS vs. authorized days or other discrepancies. Evaluates clinical documentation in patient records and escalates issues through the established chain of command. Tracks avoidable days accurately in the avoidable day module in EPIC. Perform accurate and timely documentation of all review activities. Job Requirements: Required Minimum EducationGraduate of an accredited/approved school of nursing: Baccalaureate degree in nursing (BSN) from an accredited school of nursing preferred.--Required Minimum Certification

  • RN with a Georgia LicenseRequired Minimum Experience
    • Strong clinical knowledge with three to five years clinical practice/experience is required--Required Minimum Skills
      • Knowledge of Case Management process. Excellent verbal and written communication

Keywords: WellStar Health System, Marietta , Registered Nurse, Central Utilization Management, Executive , Marietta, Georgia

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Director Of Underwriting
Description: MORTGAGE UNDERWRITING DIRECTOR CAREER OPPORTUNITY Are you interested in a stable career and amazing benefits with a leader in the residential mortgage industry Are you a natural leader who loves working (more...)
Company: Resolution Technologies, Inc.
Location: Decatur
Posted on: 01/19/2021

Cracker Barrel: Restaurant Manager
Description: Job DescriptionOverview: When working at Cracker Barrel, you will enjoy a fast-paced, family environment, where we treat every guest as a guest in our own home. You'll be Pleasing
Company: Cracker Barrel
Location: Conyers
Posted on: 01/19/2021

Director, Cyber Threat Operations
Description: Every day, Global Payments makes it possible for millions of people to move money between buyers and sellers using our payments solutions for credit, debit, prepaid and merchant services. Our worldwide (more...)
Company: TSYS
Location: Atlanta
Posted on: 01/19/2021


VP Head of Diversity Equity & Inclusion
Description: Reporting to the Chief People Officer CPO ,--the--head of--Diversity, Equity--and Inclusion DEI is responsible for championing, developing, executing and overseeing Company's DEI strategy and programs. (more...)
Company: ExecuNet
Location: Atlanta
Posted on: 01/19/2021

Shopper Insights Manager
Description: Shopper Insights ManagerVideoMining Corporation-----Remote PositionPosition SummaryVideoMining Corporation is seeking a Shopper Insights Manager to join its Analytics team. The person will work closely (more...)
Company: VideoMining
Location: Atlanta
Posted on: 01/19/2021

Treasury Manager
Description: The Treasury Manager will be responsible for the following key activities: Lead efforts to complete separation from Terminix through design and implementation of stand-alone SMB treasury processes, technology (more...)
Company: ServiceMaster
Location: Decatur
Posted on: 01/19/2021

Product Marketing Manager
Description: Title: Product Marketing Manager Location: Atlanta, GA Salary: 80,000 - 85,000k Duration: Perm Due to client requirement, applicants must be willing and able to work on a w2 basis. Our clinet offers (more...)
Company: Eliassen Group
Location: Decatur
Posted on: 01/19/2021

NetSuite Director
Description: RSM has an opening for a functional Consulting Practice Director focused on NetSuite in our Technology and Management Consulting TMC Practice This is a client-facing role focusing on the sale, implementation, (more...)
Company: RSM International
Location: Atlanta
Posted on: 01/19/2021

Commercial Account Manager
Description: Job DescriptionWhat is a Customer Account Manager CAM At Advance Auto Parts, a Customer Account Manager CAM sells or oversees the selling of automotive products for repair or distribution to automotive (more...)
Company: Advance Auto Parts
Location: Buford
Posted on: 01/19/2021

Marketing Manager
Description: Job DescriptionMarketing/Media ManagerDirect HireRemoteRequired Skills And Qualifications Bachelor'
Company: HUNTER Technical - htrjobs.com
Location: Atlanta
Posted on: 01/19/2021

Log In or Create An Account

Get the latest Georgia jobs by following @recnetGA on Twitter!

Marietta RSS job feeds