Utilization Management RN Remote

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

• 4/10hr shifts (630am - 5pm / 7am - 530pm) with a weekend rotation

  ​Monitor admissions and perform initial and continued stay medical necessity reviews.

• Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement.

• Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials.

• Build relationships to promote interdisciplinary collaboration.

• Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization.

• Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
• Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
• Ability to understand differences between notification, reference, and authorization numbers.
• Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.
• Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff.

• Associate's of Nursing [Required]
• Bachelor's of Nursing [Preferred]

• 3+ years clinical nursing [Required]
• 5+ years clinical nursing in an acute care setting [Preferred]
• Experience working in electronic health records [Preferred]
• Utilization Management or Case Management [Preferred]

• Registered Nurse (RN) [Required] AND
• Accredited Case Manager (ACM) [Preferred] OR
• Certified Case Manager (CCM) [Preferred]

At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. More than 100,000 skilled and compassionate caregivers in physician practices, hospitals, outpatient clinics, skilled nursing facilities, home health agencies and hospice centers provide individualized, wholistic care.Our Christian mission, shared vision, common values and focus on whole-person health is our commitment to making communities healthier with a unified system: 51 hospital campuses and hundreds of care sites in diverse markets throughout nine states.