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Utilization Management RN

Company: University of Virginia
Location: Charlottesville
Posted on: June 12, 2019

Job Description:

Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management process. They collaborate with physicians and other members of the healthcare team to promote and adhere to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission vision and values of UVA Medical Center.+ Analyze and evaluate complex medical documentation:+ Demonstrates competence in interpretation of clinical data, and the application of UM tools.+ Collaborates with physicians and care team: Attending, resident, mid level practitioners.+ Utilizes judgement and critical thinking in determining what cases to refer for second level review to external physican consultants and internal UVA UR MDs.+ Provides complete accurate and timely clinical data to Insurance companies.+ Utilizes judgement and critical thinking to determine if denied cases will be appealed utilizing medical, contract and payor rules.+ Conducts appeals with external entities and Consultants.+ Manages appealed cases including external review and resolution for Billing.+ Actively supports the financial mission of the department.+ Practices according to department standards.+ Assumes responsibility for professional development of self and contributes to and assists with the professional development of others.+ Demonstrates leadership in the UM role.Position Compensation Range: $59,072.00 - $94,515.20 AnnualMINIMUM REQUIREMENTS+ Education: Bachelor of Science in Nursing from accredited nursing program.+ Experience: 2 years acute care hospital experience. Experience in Adult Med/Surg, Pediatrics, Oncology or Critical Care preferred. Experience in managed care, UM or CM preferred. Previous nursing leadership preferred.+ License/Certification: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. Certification in case management preferred.+ Job requires sitting for prolonged periods. Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly.PHYSICAL DEMANDSJob requires sitting for prolonged periods. Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly._The University of Virginia, including the UVA Health System and the University Physicians Group are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information._In 1819, Thomas Jefferson founded the University of Virginia and inaugurated a bold experiment. Two centuries later, Jeffersons vision thrives. Across Grounds - and throughout the world - UVA students, faculty, staff and alumni challenge convention, break barriers and pursue the greater good.The University of Virginia is made up of eleven schools and affiliated foundations in Charlottesville plus the College at Wise in Southwest Virginia.The University of Virginia Health System is a renowned academic medical center committed to providing outstanding patient care, educating tomorrow's health care leaders and discovering new and better ways to treat diseases. The University's Medical Center, School of Medicine and Physicians Group are recognized for their excellence in patient care, education and research.At UVA, we offer a rich collection of benefits, which have long been recognized and valued for their comprehensiveness and competitiveness in the market. In addition to a robust array of traditional benefits such as health care, time off, and retirement, UVA offers a comprehensive list of benefits and services to help staff and faculty meet their personal and family needs.

Keywords: University of Virginia, Charlottesville , Utilization Management RN, Healthcare , Charlottesville, Virginia

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