Atrium Health Charlotte is seeking a Registered Nurse (RN) Clinical Coordinator, Utilization Review for a nursing job in Charlotte, North Carolina.
Overview
Assists and collaborates with multidisciplinary team in providing specific clinical information that meets expectations of third party payors; responsible for timely provision/flow of clinical information to/from third party payor and multidisciplinary team to ensure certification/approval of inpatient services. Provides clinical expertise/knowledge support to the payor specialists' and reviews clinical information prior to sending to payor as needed to ensure information meets acute clinical care guidelines as determined by Clinical Care Management.
Essential Functions
• 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.
• Coordinates appeals when NC Medicaid cases are denied with the DHS Hearing Officer.
• Ensures that essential information and necessary forms are forwarded to the Medical Audit and Appeals Department of CHS.
• 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.
• Refers pertinent information to the Medical Director, and/or Service Director in a timely manner.
• Collaborates on a daily basis with the physician to plan and implement the medical and multidisciplinary plan of care, utilizing clinical pathways when appropriate and available.
• Works with team members and leadership to identify problem areas and implement resolutions.
• Develops and maintains accurate case records of assigned cases. Documents in the patient's medical record according to department and facility standards
Education, Experience and Certifications
Graduation from an accredited School of Nursing required; Bachelor’s Degree in Nursing preferred. NC RN licensure required. Related experience preferred. Basic Life Support for Healthcare Provider (BLS HCP) from AHA required.
Physical Requirements
Works in an office setting, extensive walking throughout the facility. Prolonged periods of sitting reviewing medical records and documentation. Repetitive wrist motion and occasional lifting of 10-20 pounds. Requires frequent verbal and written communication in English. Intact sight and hearing with or without assistive devices is required.
Atrium Health Charlotte Job ID #125674. Posted job title: Rn Coordinator - Utilization Review Atrium Health Clinical Care Management Remote Prn Days
Headquartered in Charlotte, NC, Atrium Health is now part of Advocate Health , the third-largest nonprofit, integrated health system in the United States, which was created from the combination with Advocate Aurora Health. In the Southeast Region, Atrium Health provides care under the Atrium Health name in Charlotte, NC, Atrium Health Wake Forest Baptist name in the Winston-Salem, NC, region, as well as Atrium Health Navicent and Atrium Health Floyd in Georgia and Alabama. Together, we are committed to providing equitable care for all. Annually, Advocate Health provides nearly $5 billion in community benefits.
Atrium Health Wake Forest Baptist
Atrium Health Wake Forest Baptist is a pre-eminent academic health system based in Winston-Salem, North Carolina. Atrium Health Wake Forest Baptist is part of Advocate Health, which is headquartered in Charlotte, North Carolina, and is the fifth-largest nonprofit health system in the United States, created from the combination of Atrium Health and Advocate Aurora Health. Atrium Health Wake Forest Baptist's two main components are an integrated clinical system - anchored by Atrium Health Wake Forest Baptist 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 academic core of Atrium Health Enterprise and a recognized leader in experiential medical education and groundbreaking research that includes Wake Forest Innovations, a commercialization enterprise focused on advancing health care through new medical technologies and biomedical discovery.
Atrium Health Navicent
Atrium Health Navicent is the leading provider of healthcare in central and south Georgia and is committed to its mission of elevating health and well-being through compassionate care. Atrium Health Navicent is part of Advocate Health, which is headquartered in Charlotte, North Carolina, and is the third-largest nonprofit health system in the United States, created from the combination of Atrium Health and Advocate Aurora Health. Atrium Health Navicent provides high-quality, personalized care in 53 specialties at more than 50 facilities throughout the region. As part of the largest, integrated, nonprofit health system in the Southeast, it is also able to tap into some of the nation's leading medical experts and specialists with Atrium Health, allowing it to provide the best care close to home - including advanced innovations in virtual medicine and care. Throughout its 125-year history in the community, Atrium Health Navicent has remained dedicated to enhancing health and wellness for individuals throughout the region through nationally recognized quality care, community health initiatives and collaborative partnerships. It is also one of the leading teaching hospitals in the region, helping to ensure viability for rural health care for the next generation.
Atrium Health Floyd
Atrium Health Floyd Medical Center is a 304-bed, full-service hospital located in Rome, Georgia. Serving as the main campus for Atrium Health Floyd, this hospital provides a certified Chest Pain Center, a designated Bariatric Surgery Center of Excellence and a Breast Imaging Center of Excellence. Atrium Health Floyd also is home to a state-designated Level II Trauma Center and a Level III Neonatal Intensive Care Unit, and has specialty centers for pediatrics, and wound care and hyperbaric therapy.
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