What are the responsibilities and job description for the RN Utilization Review Coordinator, REMOTE position at GA_SMHHS St. Mary'S Health Care System, Inc.?
Employment Type: Full time Shift: Day Shift Description: The Utilization Review (UR) Coordinator works, in collaboration with a multidisciplinary team that includes, but is not limited to, physicians, nurses, patient access, and billing staff, along with external insurance payers, to ensure patients progress along the continuum of care in an efficient and cost-effective manner that ensures quality outcomes. UR Coordinator utilizes established guidelines to support appropriate level of care throughout hospitalization and serves as a liaison between the hospital and external payers on issues related to severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services. Required Education, Experience and Certification/Licensure Licensure/Certification/Registration: Current GA RN license. BLS required. Education: Must be a graduate of an accredited school of nursing, BSN recommended. Experience: Three to five years related experience and clinically relevant knowledge. Required Skills and Abilities Clinical and analytical skills necessary to facilitate collection of patient clinical information from medical record and to objectively apply various criteria as dictated by exterior payers. Strong organization and prioritization skills. Strong interpersonal and communication skills, including telephonic and electronic. Ability to concentrate and pay close attention to detail. Computer Skills: Required: Basic keyboarding skills Preferred: EPIC Microsoft Word Microsoft Teams Microsoft Outlook Microsoft Excel Degree of Supervision Required: Indirect and periodic supervision. Must be capable of working independently. Ages of Patients Served: This position requires competence in assessment, treatment, and/or care for the age groups indicated. The staff member must be able to demonstrate the knowledge and skills necessary to provide care, based on physical, psycho/social, educational, safety and related criteria, appropriate to the age of the patients served in her assigned area. The skills and knowledge needed to provide such care might be gained through education, training, or experience. Our Commitment to Diversity and Inclusion Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.
