Supports Carilion's hallmarks of service excellence and quality for all job responsibilities. Directs the Carilion Medical Center's Utilization Management (UM) services. Coordinates departmental functions with hospital service lines to ensure adherence to Federal, State and payor rules and regulations regarding utilization management policy and procedures. Provides internal and external leadership for the UM team focusing efforts on utilization review, denials management, and compliance regarding all UM processes and regulatory requirements. Communicates, organizes, prioritizes, coaches, and problem solves with all members of the UM team to ensure appropriate and accurate documentation that results in support for appropriate placement and reimbursement for the level of services rendered for all patients. Represents the Utilization Management department throughout the facility as requested.
Minimum Qualifications Required
Education:. Bachelors Degree in Nursing, Health Care or related field required. Masters Degree in Nursing or related health care preferred.
Experience: Three years of utilization management or care coordination experience as appropriate for the role that demonstrates increased and/or diversified responsibility focus on care coordination, clinical outcomes, discharge planning and quality improvement. Must possess knowledge of the continuum of care services and clinical protocols.
Licensure, certification, and/or registration: RN with current unrestricted license with the Virginia State Board of Nurse Examiners.
Other Minimum Qualifications:. Ability to problem solve and to communicate effectively. Demonstrated effective leadership, training, and usage of interpersonal skills to manage a team of clinicians through change. Strong oral and written communication skills. Basic computer skills, knowledge of EPIC, Interqual, E-Discharge and Servo Formal training in utilization review criteria/processes highly desirable.
Inspiring Better Health at Carilion Clinic
Every day at Carilion Clinic, our employees come together to inspire better health in our patients, their families and our communities. Explore how you can be a part of this diverse, innovative and interdisciplinary patient-centered team, and find out how you can make a difference in the lives of others.
As an employee, you can take advantage of our competitive pay, various scheduling options, continuing education opportunities and excellent benefits.
Based in Roanoke, Va., Carilion Clinic includes multi-specialty physician practices, seven not-for-profit hospitals and the Virginia Tech Carilion School of Medicine and Research Institute in partnership with Virginia Tech.
Service Excellence and Quality are hallmarks of Carilion Clinic. As a team member, you will be expected to consistently deliver the best in care and customer service. As an employee, you will demonstrate respect, dignity, kindness and empathy in each encounter with our patients, families, visitors and with each other.
Equal Opportunity EmployerMinorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.
Shift: M-F, 8:00 a.m. - 5:00 p.m.