RN Utilization Management Coordinator, Part Time

Trinity Health • Grand Rapids, MI

2d

About The Position

Performs Utilization Reviews for assigned cases, interacting with insurance representatives, case managers, and the physician advisor as needed. Coordinates the utilization review activities within the CQM department and serves as interdepartmental liaison as it relates to changes in the utilization management industry. In addition, assists with denial management of cases denied both concurrently and retrospectively. Status available: Part-time - 24 hours per week

Requirements

• Minimum Bachelors of Nursing (BSN)
• Minimum Current State of Michigan Registered Nurse License.
• Three years acute care experience as a Registered Nurse or five years demonstrated experience in a similar role
• Current licensure to practice nursing in Michigan
• One year of experience at Trinity Health and two years of clinical experience in nursing.

Responsibilities

• Performs accurate, complete utilization reviews on patients as assigned.
• Identifies cases requiring pre-certification and performs certification calls in a courteous, organized, timely, and efficient manner.
• Handles utilization denials/appeals in collaboration with manager/director, physician advisor, and other appropriate hospital departments.
• Performs necessary concurrent and retrospective changes in patient status (observation versus inpatient) per standard process.
• Demonstrates efficiency on Healthquest and Cerner computer systems.
• Sets and maintains a professional atmosphere which encourages open communication and demonstrates attention to the needs and concerns of patients, families and health team members.
• Identifies inappropriate admissions, non-acute days ,, under/over utilization of resources, and reports to Manager..Proactively utilizes established criteria plus re-certification data to alert case manager.

Benefits

• Competitive compensation
• DAILYPAY
• Benefits effective Day One!
• No waiting periods.
• Full benefits package including Medical, Dental, Vision, PTO, Life Insurance, Short and Long-term Disability
• Retirement savings plan with employer match and contributions
• Opportunity for growth and advancement throughout Trinity Health
• Tuition Reimbursement

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level