Vanderbilt University Medical Center
Utilization Management Specialist, ED (RN required) - VTHH (Hybrid)
Vanderbilt University Medical Center, Tullahoma, Tennessee, United States, 37388
Utilization Management Nurse
Facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring that the appropriate admission status is ordered. The nurse conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when appropriate. Refers and consult with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review criteria to support hospital stay. Key responsibilities include: Facilitating optimal reimbursement through certification and denial processes. Facilitating throughput of patients admitted urgently or emergently through the emergency department. Participating as an active partner with multidisciplinary team members to ensure case is in the appropriate level of care setting. The responsibilities listed are a general overview of the position and additional duties may be assigned. Technical capabilities include: Medical Terminology & Documentation (Novice): Possesses sufficient fundamental proficiency to successfully demonstrate medical terminology and documentation in practical applications of moderate difficulty. Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business support applications as needed. Utilization Review (Intermediate): Demonstrates expertise of utilization review in practical applications of a difficult nature. Possesses sufficient knowledge, training, and experience to independently complete clinical review to obtain payor authorization. Demonstrates mastery in InterQual Level of Care Criteria and Milliam Care Guidelines. Able to train and educate by setting the example, giving technical instruction, providing leadership, and generally raising the level of performance of others while on the job. Interdisciplinary Education (Novice): Seeks to provide education by collaborating with providers and other members of the health care team to ensure that the patient is placed in the appropriate level of care setting. Our nursing philosophy is that highly skilled and specialized nursing care is essential to Vanderbilt University Medical Center's mission of quality in patient care, education and research. We believe nursing is an applied art and science focused on helping people, families and communities reach excellent health and well-being. As a Vanderbilt University Medical Center employee, you make a difference to our patients and their families by bringing compassion and care to those in need of hope and healing. Employee benefits include: Affordable high quality health plan options Dental and/or vision plan 403 (b) retirement plan Paid time off (flex PTO) Tuition reimbursement and adoption assistance (maximums applied) Short-long term disability Subsidized backup childcare And many more... Ask us about our current inpatient nursing supplemental pay program! Core accountabilities include: Organizational impact Problem solving/complexity of work Breadth of knowledge Team interaction Core capabilities include: Supporting colleagues Delivering excellent services Ensuring high quality Managing resources effectively Fostering innovation Position qualifications include: Certifications: LIC-Registered Nurse - Licensure-Others Work experience: Relevant work experience Experience level: 1 year Education: Bachelor's Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.
Facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring that the appropriate admission status is ordered. The nurse conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when appropriate. Refers and consult with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review criteria to support hospital stay. Key responsibilities include: Facilitating optimal reimbursement through certification and denial processes. Facilitating throughput of patients admitted urgently or emergently through the emergency department. Participating as an active partner with multidisciplinary team members to ensure case is in the appropriate level of care setting. The responsibilities listed are a general overview of the position and additional duties may be assigned. Technical capabilities include: Medical Terminology & Documentation (Novice): Possesses sufficient fundamental proficiency to successfully demonstrate medical terminology and documentation in practical applications of moderate difficulty. Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and business support applications as needed. Utilization Review (Intermediate): Demonstrates expertise of utilization review in practical applications of a difficult nature. Possesses sufficient knowledge, training, and experience to independently complete clinical review to obtain payor authorization. Demonstrates mastery in InterQual Level of Care Criteria and Milliam Care Guidelines. Able to train and educate by setting the example, giving technical instruction, providing leadership, and generally raising the level of performance of others while on the job. Interdisciplinary Education (Novice): Seeks to provide education by collaborating with providers and other members of the health care team to ensure that the patient is placed in the appropriate level of care setting. Our nursing philosophy is that highly skilled and specialized nursing care is essential to Vanderbilt University Medical Center's mission of quality in patient care, education and research. We believe nursing is an applied art and science focused on helping people, families and communities reach excellent health and well-being. As a Vanderbilt University Medical Center employee, you make a difference to our patients and their families by bringing compassion and care to those in need of hope and healing. Employee benefits include: Affordable high quality health plan options Dental and/or vision plan 403 (b) retirement plan Paid time off (flex PTO) Tuition reimbursement and adoption assistance (maximums applied) Short-long term disability Subsidized backup childcare And many more... Ask us about our current inpatient nursing supplemental pay program! Core accountabilities include: Organizational impact Problem solving/complexity of work Breadth of knowledge Team interaction Core capabilities include: Supporting colleagues Delivering excellent services Ensuring high quality Managing resources effectively Fostering innovation Position qualifications include: Certifications: LIC-Registered Nurse - Licensure-Others Work experience: Relevant work experience Experience level: 1 year Education: Bachelor's Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.