[Hiring] Utilization Management RN @AdventHealth

Role Description

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

• Maintain thorough knowledge of payer guidelines and regulatory requirements and manage 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, monitor daily discharge reports, and follow up with insurance carriers to obtain complete authorization.

Qualifications

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

Requirements

• 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]
• Accredited Case Manager (ACM) [Preferred]
• Certified Case Manager (CCM) [Preferred]

Benefits

• 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

Company Description

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team.