ED Utilization Management RN FT Nights

Description ED Utilization Management RN AdventHealth Gordon (Remote) Location Address: 1035 Red Bud Road, Calhoun, GA Top Reasons To Work At AdventHealth Gordon Gordon: Faith based organization Employee Referral Program Educational Reimbursement Plan Located in the foothills of the North Georgia Mountains Co-workers that feel like family Work Hours/Shift: Fulltime Nights with weekend rotation You Will Be Responsible For: Performs pre-admission status recommendation in Emergency Department or elective procedure settings as assigned, to communicate with providers status guidance based on available information.

Leverages clinical experience and critical thinking to provide status assignment recommendations to providers within an abbreviated timeframe.

Maintaining thorough knowledge of payer guidelines, familiarity with payer processes for initiating authorizations, and following through accordingly to prevent loss of reimbursement, including the management of concurrent and pre-bill denials.

Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate management of claims.

Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.

Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis: Assignment of appropriate patient status and level of care.

Ability to work independently and exercise sound judgment in interactions with any physicians and/or other interdisciplinary team members.

Qualifications What You Will Need: REQUIRED:
• Current and valid license to practice as a Registered Nurse (ADN or BSN) required.

• Minimum three years acute care clinical nursing experience required.

• Minimum two years Utilization Management experience, or equivalent professional experience.

• Excellent interpersonal communication and negotiation skill.

• Strong analytical, data management, and computer skills.

• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.

PREFERRED:
• Bachelor of Science in Nursing – or other related BS or BA in addition to Nursing
• Clinical experience in acute care facility – greater than five years
• Minimum four years Utilization Management within acute care setting
• Experience working in electronic health records of at least two years Job Summary: The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine legitimacy of hospital admission, treatment, and appropriate level of care.

This coverage will be required twenty-four hours per day, seven days a week including weekends, holidays and overnight.

The Emergency Department UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations.

The Emergency Department UM RN is responsible to document findings based on department and regulatory standards.

When screening criteria does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.