15 department manager Jobs in greenville, nc
Vidant Health is Hiring an Utilization Review Specialist (Emergency Department-Days) Near Greenville, NC
ECU Health
About ECU Health Medical Center
ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Position Summary
The Utilization Review Specialist will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Perform Utiliztion Review according to CMS and commercial payor guidelines. Participate in denial / appeal process.
Responsibilities
- Utilizes the nursing process to assess, plan, implement and evaluate the utilization management needs for patients in assigned caseload. Performs utilization management activities using approved screening criteria.
- Provides follow up with appropriate resource for utilization management issues/non-compliance.
- Clinical Progression and Utilization Management. Participates in quality improvement (QI) activities.
- Advances knowledge and skills in case / utilization management.
- Collaborates effectively with departmental staff to achieve goals and objectives.
- Associates Degree in Nursing required; BSN preferred.
- NC RN licensure required.
- If ADN prepared must have 5 years experience in an acute care hospital; home health agency; commercial insurance company; case management.
- If BSN prepared must have 3-5 years experience in an acute care hospital; home health agency; commercial insurance company; case management.
- A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience; Masters Degree in health related field can substitute for 1 year of experience.
Shift: 10 hour days with weekend rotation in the Emergency Department
Job Summary
Full Time
$64k-89k (estimate)
08/01/2024
08/16/2024
vidanthealth.com
TARBORO, NC
7,500 - 15,000
1998
NIKA POWELL
$1B - $3B
Ancillary Healthcare
Related Companies
About Vidant Health
Vidant Health is the Corporation which owns and operates 9 hospitals and numerours physician practices in eastern North Carolina. The mission of Vidant Health is "to enhance the quality of life for the people and communities we serve, touch and support."
The following is the career advancement route for Utilization Review Specialist (Emergency Department-Days) positions, which can be used as a reference in future career path planning. As an Utilization Review Specialist (Emergency Department-Days), it can be promoted into senior positions as an Utilization Review Manager - Home Care that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Specialist (Emergency Department-Days). You can explore the career advancement for an Utilization Review Specialist (Emergency Department-Days) below and select your interested title to get hiring information.
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Quotes from people on Utilization Review Specialist job description and responsibilities
Utilization Review Specialists ensure that Doctors and Nurses choose only the best treatments for them.
03/11/2022: Fort Myers, FL
Utilization review typically refers to the review of services that have already been delivered, while utilization management often refers to the review of coverage for future medical services.
02/16/2022: Louisville, KY
Assess plans for patient care and determine what treatment is appropriate and most cost-effective
02/15/2022: Augusta, GA
Analyze electronic medical records, and inform medical staff whether a medical claim is denied,
03/11/2022: Boston, MA
Prepares and submits regular reports on utilization control and on review activities.
02/26/2022: Reading, PA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Utilization Review Specialist jobs
Know where to find utilization review jobs.
03/13/2022: Clarksville, TN
Create a utilization review cover letter.
02/18/2022: Reno, NV
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03/16/2022: New London, CT
Set up documentation shortcuts.
03/05/2022: Lawton, OK
Take the certification examination.
05/08/2022: New Bedford, MA
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