Prior Authorization Utilization Review Jobs in Georgia

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JOB DESCRIPTION: The Clinical Utilization Review Nurse Preceptor (UR RN Preceptor) will be responsible for training, mentoring, and coaching for the Utilization Review Department. The UR RN Preceptor must be an expert in the utilization review functions and able to cover any role at any given time as well as manage an active UR assignment/caseload. The UR RN Preceptor will be regarded as a clinical expert, leader, and role model within the Utilization Review Department as it relates to the understanding and application of the Utilization Review process in its entirety. The UR RN Preceptor will have expert clinical skills as well as an in depth understanding of the revenue cycle as a whole. The UR RN Preceptor will demonstrate foresight regarding the impact of both the clinical and administrative roles within the utilization review process based on critical thinking, intuition, and experience. The UR RN Preceptor facilitates efforts to support compliance and adherence to standard work, policies and procedures, clinical criteria guidelines, status designation, notification and authorization, compliance and regulatory standards, and case management systems. The UR RN Preceptor understands the key performance metric indicators for the department and supports the team in reaching them. The UR RN Preceptor remains up to date with industry standards, regulatory and compliance standards/updates, and keeps informed of best practices within the industry in an effort to incorporate innovative solutions into the Utilization Review Department. The UR RN Preceptor will be responsible for new hire onboarding, training, and competency completion. In addition, the UR RN Preceptor will be responsible for ongoing departmental education to ensure utilization review is a high performing department. This will consist of regular audits of each staff member which will assist with identification in knowledge gaps and/or education needs. The UR RN Preceptor will be responsible for developing and executing individualized training plans as needed based on audits. The UR RN Preceptor will assist with the development of both clinical and administrative skills by ensuring the staff have opportunities to acquire necessary knowledge, skills, and attitudes to fulfill the expectations of their roles. The UR RN Preceptor will role model and encourage these skill sets. The UR RN Preceptor will coordinate with Case Management leaders to ensure policies, procedures, and standard work are consistently updated and maintained and employees are trained appropriately and timely in order to ensure consistent expectations and maintain quality throughout the department. The UR RN Preceptor is required to ensure all training materials are kept organized, updated, and readily available for reference at any time. The UR RN Preceptor must ensure yearly and new competencies/validations are completed and filed for employees for all new hires as well as for new initiatives, projects, and/or processes. The UR RN Preceptor will play a vital role in partnering with Physician Advisors to ensure the Physician role as well as the UR RNs roles are continually optimized. The UR RN Preceptor functions as part of the departments leadership team and provides direct coverage/support to leaders as necessary. Must meet expectations on yearly evaluation and may not have any active performance management or disciplinary action. Successful completion of yearly competencies. MINIMUM QUALIFICATIONS: Must have a valid, active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board. Bachelors degree in nursing required. Masters degree in Nursing, Education, or related field preferred. 3-5 years recent healthcare experience. 3-5 years experience in UR. Minimum 1 year as UR RN II or equivalent experience. Case Management certification preferred. PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.