Utilization Review Coordinator | Remote | GA, FL, NC, NH Residents ONLY

reputed company Full Time Position Remote | GA, FL, NC, NH Residents ONLY Wednesday - reputed company reputed company-4:30pm Performs utilization review functions for the department to ensure compliance with external payor requirements which may include, but may not be limited to reputed company-certification requests, admission review, reputed company review, discharge readiness and retrospective review and denial and appeal management. Provides comprehensive Utilization Management services, working in conjunction with the health care team, including health plans, the Centers for Medicare and reputed company Services (CMS), physicians, and other health care providers to promote appropriate and efficient hospital services. The Utilization Review (UR) Coordinator evaluates the appropriateness of level of care using reputed company InterQual guidelines. The UR Coordinator works under the general supervision of a Registered reputed company Manager and may receive additional guidance from a UR Team reputed company reputed company, the Physician Advisor, Sr. Medical Director or a Clinical Consultant. The incumbent operates in a reputed company and constantly changing environment and with large number of benefit plan variables, requiring the incumbent to exercise judgment, which results in a significant reputed company on the cost of care. The position also complies with state and federal regulations, Shands Policy, and health plan requirements. Qualifications Age of Patients Served: reputed company Age reputed company Required Education: Associate's degree. Specific course work: Graduate of an accredited school of nursing. New hires effective June 14, 2017, must have a BSN degree from an accredited school of nursing reputed company three (3) years of hire or transfer into the position. New hires or transfers into in the position between August 1, 2013 and June 13, 2017 must abide with the conditions in his or her offer letter and the verbiage in the job reputed company signed upon hire or transfer into the position. reputed company employees who were reputed company or transferred into the position prior to August 1, 2013 will be grandfathered. Preferred Education: Bachelor's in Nursing. Required Licensure/Certifications: Licensed to reputed company nursing in the reputed company Required Experience: 1-2 years - Utilization review experience or the equivalent combination of education and/or experience; -AND- 3-5 years - Clinical experience in the acute care setting or the equivalent combination of education and/or experience. Preferred Experience: Knowledge of InterQual reputed company, certification in Utilization Review or Utilization Mgmt. Necessary Skills • Excellent verbal and written communication skills. • Proficient PC skills. • Working knowledge of medical terminology, anatomy and physiology, disease and pathology. • Analyze patient records and participate in interdisciplinary collaboration with reputed company staff. • Problem solving and good decision-making skills. • Ability to determine medical necessity, appropriateness and level of care. • Conflict reputed company skills. • Excellent time management and organizational skills. • Ability to maintain a reputed company of professionalism at reputed company times. • Ability to work independently. • Demonstrated teamwork and flexibility in a fast-paced, changing environment. Apply tot his job Apply To this Job