Remote Utilization Review Nurse Jobs in Raleigh, NC

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Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

Duke Nursing Highlights:

• Duke UniversityHealth System is designated as a Magnet organization
• Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 Nurses.
• Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
• Duke University Health System has 6000 + registered nurses
• Quality of Life: Living in the Triangle!
• Relocation Assistance (based on eligibility)

REMOTE POSITION: Monday - Friday

General Description of the Job Class:

Pre-Service Verification is an integral part of the revenue cycle, responsible for the verification of patient insurance eligibility, prior authorization, and medical necessity for physician and hospital inpatient and outpatient services provided across Duke Health.

The Strategic Services Associate supports the management team and acts as a liaison to stakeholders (service lines, clinic leadership, providers, revenue managers, revenue cycle operational teams, etc.) to support eligibility, prior authorization, and medical necessity standardized processes. This position evaluates and implements sustainable system workflows that improve operational performance and clear lines of responsibility between clinical, clinic, and pre-service verification teams. The Strategic Services Associate contributes to the achievement of department goals through the development and leadership of performance improvement activities.

Duties and Responsibilities of this Level:

Performance Improvement 60%

Design and implement strategies for enhancing performance, reducing denials, and write-offs through utilization of performance improvement techniques and methodologies.

Evaluate operational workflows and identify components that will improve operational efficiency by leveraging technology/bot/automation.

Implement and maintain technology solutions for the department.

Recommend policy/procedure and training documentation related to initiatives and projects.

Establish department performance targets.

Maintain full knowledge of departmental operations and act as a subject matter expert for eligibility, authorization, and medical necessity.

Develop, maintain, and enhance knowledge of Electronic Health Record system and third-party vendor functionality to support recommendations on optimal workflows.

Serve as an expert resource on performance improvement methodologies.

Collaboration 30%

Maintain liaison with service line and other revenue cycle departments as it relates to pre-service verification operations.

Partner with supporting clinics to educate on pre-service verification processes and resolve system related workflows impacting operations.

Communicate overall strategy for departmental improvement and develop strategies to meet performance metrics.

Serve as a project manager for interdisciplinary teams.

Ensure adequate training and documentation is provided on new and changing processes.

Other Duties 10%

Promote PRMO strategic vision, mission, and purpose while emphasizing teamwork and results.

Support organizational diversity and equal treatment for all employees.

Create and foster a department culture that provides a satisfying and enriching environment in which staff can be developed and retained.

Interact with and provide timely verbal/written responses to all stakeholders (patients, providers, payors, and departmental personnel).

Acknowledge management requests and emails in a professional, timely manner.

Attend meetings and participate in Work Culture initiatives, committees or workgroups, as assigned.

Accomplish all tasks as assigned.

Perform other related duties incidental to work described herein.

Required Qualifications at this Level

Education: Bachelors degree in a business or health-related field is required.

Experience: Minimum of 5 years work experience, including 3 years of experience with significant responsibility for performance/ process improvement. Experience leading work teams required.

Degrees, Licensure, and/or Certification: Knowledge, Skills, and Abilities: Effective written and verbal communication skills Ability to communicate with customers/staff with diverse educational backgrounds Analysis of data and processes for opportunities for improvement Ability to manage numerous diverse projects simultaneously through effective priority setting, efficient use of time, organization Knowledge of revenue cycle operations Attention to detail and accuracy Computer literacy

Distinguishing Characteristics of this Level N/A

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions:

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Employment Type: FULL_TIME

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