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Registered Nurse - Chapel Hill, NC, United States - UNC Health
Description
UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job in Chapel Hill, North Carolina.Specialty:
Care Manager
~ Shift: 8 hours, days
~ Employment Type:
Staff
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
This person is based at the Hedrick building and is 100% on-site.This individual combines clinical, business, and regulatory knowledge to reduce significant financial risk caused by concurrent and retrospective denial of payments for rendered services.
This individual is highly developed in assessing clinical documentation for medical necessity, patient status determination, knowledge of government and commercial payor requirements, as well as denial management.
Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness.
The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum.
In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity.
Interface is completed verbally, via email, data base tasks, or other electronic communication and via telephone.Clinical Review Process - Uses approved criteria and conducts admission review/status change review within 24 hours of patient admission to the hospital to ensure appropriateness of the setting and timely implementation of the plan of care.
Partners with physicians, nursing, and other care providers to help ensure timely and accurate documentation of patient data and treatments.
Communicates daily with the Case Manager to manage level of care transitions & appropriate utilization of services. Utilizes high risk screening criteria to make appropriate referrals to Manager.Discharge Facilitation - Identifies patient/families with the complex psychosocial, on-going medical discharge planning issues, continuing care needs by initiating appropriate case management referrals.
Initiates appropriate social work referrals.Using approved criteria, conducts continued stay and quality reviews to monitor the patient's progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective.
Enters all pertinent review data into the correct computer system in a timely manner. Consults with Physician Advisor as necessary to resolve barriers through appropriate administrative and medical channels.Utilization Outcomes Management - Monitors and guides to trend interdisciplinary documentation and guides medical staff in documentation that will assist in coding accuracy, enhance quality of care, reflect accurate severity of illness and appropriate reimbursement.
Facilitates patient movement to appropriate (acuity) level of care including observation status issues through collaboration with patient/family, multidisciplinary team, third party payors and resource center.
Assists in coordination of practice parameter development with the assigned departments/sections/specialties of Medical Staff. Oversees collection and analysis of patient care and financial data relevant to the target case types. Directs delivery of notifications to patients (includes traveling to hospital(s) to deliver notifications.Graduation from a state-accredited school of professional nursing
Job Details Legal Employer:
Entity: UNC Medical Center
Organization Unit:
UNCH Care Mgmt Operations
Work Type:
Full Time
81 per hour (Hiring Range)
Exempt From Overtime:
Exempt: Yes
This is a State position employed by UNC Health Care System.
Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities.
UNC Health Job ID # Posted job title:
rn utilization manager - care management operations
About UNC Health
UNC Health is an integrated health care system owned by the state of North Carolina and based in Chapel Hill.
UNC Health is committed to empowering health, not just health care.UNC Health and our 40,000 employees, continue to serve as North Carolina's Health Care System, caring for patients from all 100 counties and beyond our borders.
We continue to leverage the world class research conducted in the UNC School of Medicine, translating that innovation to life-saving and life-changing therapies, procedures, and techniques for the patients who rely on us.
