Additional Information
Hello,
Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:
Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.
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Thank you,
Human Resources
Important Applications Instructions:
Please complete this application in entirety by providing all of your work experience, education and certifications/
license. You will be unable to edit/add/change your application once it is submitted.
Job Requisition ID:
R00046700
Job Category:
Nursing
Organization:
Utilization Review
Location/s:
Main Campus Jackson
Job Title:
RN - Utilization Reviewer - Coordinated Care - PT - Remote
Job Summary:
Accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria. Reports quality of care issues identified during the um process to the appropriate manager. To perform job duties in accordance with the medical center's purpose.
Education & Experience
Four (4) years RN experience, one (1) year of which must have been in performance improvement, utilization review, or case management.
InterQual experience preferred.
CERTIFICATIONS, LICENSES OR REGISTRATION REQUIRED:
Valid RN license. CPUM (certified professional in utilization management), ACM (accredited case manager), or CCM (certified case manager) preferred.
Knowledge, Skills & Abilities
Knowledge of the aspects of utilization review. Excellent interpersonal verbal and written communication and negotiation skills. Skills in the use of personal computers and related software applications.
Ability to gather data, compile information, and prepare reports. Ability to identify process improvements. Good working knowledge of and understanding of medical procedures and diagnoses, procedure codes, including ICD-10, CPT, and DSM-IV codes.
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Ability to work independently and exercise sound judgement in interactions with physicians, payers, and patients and their families. Demonstrate commitment to the organIzation's mission and the behavioral expectations in all interactions and in performing all job duties. Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and commitment to continuous quality improvement (CQI) process.
Independent, focused and follow written instructions. Ability to use medical necessity guidelines with minimal supervision. Equipped to work remotely to include hardware with high speed internet via cable and Windows 10
Ummc · Jackson, MS