RN Supervisor, Utilization Management in Care Coordination, Winston Campus

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Wake Forest Baptist Health
Published
February 18, 2021
Location
Wake Forest, North Carolina
Category
Job Type

Description

Job Description
Job Title:
RN Supervisor, Utilization Management in Care Coordination, Winston Campus
Job ID:
46425
Location:
 
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
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Major Duties

RN Supervisor, Utilization Management

Care Coordination

Winston Campus

Full time, 40 hours salaried

JOB SUMMARY:

Collaborates with social workers, case managers, peers, and third-party payers to assist with clinical information.  Responsible for timely provision/flow of specific clinical information to third-party payers to help ensure certification/approval of inpatient, observation and post-discharge days.  Identifies and addresses staffing issues.  Maintains and shares knowledge related to regulations and compliance.

EDUCATION/EXPERIENCE: 

  • Completion from an accredited Nursing Program with five years clinical experience
  • one year experience in Utilization Management required.
  • Academic medical center experience preferred.
  • Leadership experience preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION: 

Current license to practice as a Registered Nurse (RN) in State of North Carolina required.

Generic Job Description

ESSENTIAL FUNCTIONS:
1. Effectively facilitates the collaboration of team members in order to evaluate and deliver needed social work/case management activities to patients and healthcare associates.
2. Provides team supervision.
3. Promotes/enhances professional standards of practice.
4. Effectively communicates and negotiates with third-party payers regarding clinical issues, and obtains authorization for the appropriate level of service.
5. Serves as a resource to the Care Coordination department in determination of severity of illness (SI) and intensity of service (IS), including observation and admission status.
6. Provides ongoing education regarding payer guidelines and current managed care issues and regulatory requirements.
7. Proactively identifies, documents, and communicates problems that impede the patient treatment process.
8. Accesses clinical data from computer systems and communicate with third-party payers.
9. Completes retroactive reviews upon request.
10. Provides age/developmentally-appropriate patient care in accordance with Age-Specific Care Guidelines for the specific age groups served.

SKILLS/QUALIFICATIONS:
Excellent communication skills
Self-motivated, self-directed, ability to work independently with minimal supervision
Well organized and detail oriented
Capable of critical thinking, reasoning, deduction and inference while displaying the ability to draw accurate conclusions
Ability to accept and incorporate critical comment
Ability to sense varying skill levels and direct instruction accordingly
Ability to work in a collaborative atmosphere
Experience with Windows and Excel

WORK ENVIRONMENT:
Clean, comfortable, office environment

PHYSICAL REQUIREMENTS:
0% 35% 65%
to to to
35% 65% 100% N/A Activity
X Standing
X Walking
X Sitting
X Bending
X Reaching with arms
X Finger and hand dexterity
X Talking
X Hearing
X Seeing
Lifting, carrying, pushing and or pulling:
X 20 lbs. maximum
X 50 lbs. maximum
X 100 lbs. maximum

 

*TMJ

How to Apply

To apply for this position, please click on the "Apply Now" button on this page.  You must complete the application process and then submit your application by clicking on the "Submit" button located at the bottom of the page titled "Submit Online Application". You will receive the following message once you hit the submit button: "You have successfully submitted your job application".

Computers are available for applying within the lobby of the Human Resources Department located at 1920 West First Street, (on the corner of Miller and First Street) Winston-Salem, North Carolina  27104. You may also call our office for assistance at (336) 716-6464.  Office hours are Monday-Friday, 8:00am-5:00pm.

If you are an individual with a disability and need reasonable accommodation to participate in the application process, please contact our Supervisor of Office Services by phone (336) 716-3367 or email at accommodationrequest@wakehealth.edu.

Equal Employment Opportunity

It is the policy of  Wake Forest Baptist Medical Center to administer all educational and employment activities without discrimination because of race, sex, age, religion, national origin, disability, sexual orientation, gender identity or veteran status (except where sex is a bona fide occupational qualification or a statutory requirement) in accordance with all local, state, national laws, executive orders, regulations, and guidelines.

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