Utilization Review Salary Jobs in Raleigh, NC (NOW HIRING)

Description

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Summary:
The purpose of this position is to provide direct coordination of inter-hospital transfers through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The overall goal of the position is to enhance the quality of inter-hospital transfer management and satisfaction and to promote continuity of care and cost effectiveness through the integrating and functions of point of entry case management, utilization review, and effective patient flow activities.

Responsibilities:
1. Capacity Planning- Attend and actively participate in daily collaborative meetings to develop and implement a hospital wide capacity management strategy. Alert hospital leaders and care team stakeholders of capacity constraints that may impact Transfer Center Operations. As necessary, meet with stakeholders in severely impacted areas to problem solve ways to facilitate throughput and expand the capacity to accept requested transfers.
2. Incoming Transfer Requests- Continually monitor work list(s) to appropriately triage patient transfer requests. Conduct and document assessment of proposed transfers and facilitate provider and caregiver consultations to develop a transfer plan per departmental guidelines. Participate in daily collaborative meetings to develop and implement a hospital wide capacity management strategy.
3. Logistics Management- Collaborate with house supervisors and clinical admitting decision makers to facilitate patient transfer activities with referring, receiving, and transporting caregivers, participating in discussions regarding appropriate assignment of level of care, care unit, provider team, and patient class. Refer non-clinical tasks as appropriate.
4. Clinical Appropriateness Assessment- Using established medical necessity criteria products and departmental guidelines perform assessments of the clinical appropriateness for proposed transfers. Escalate situations of questionable clinical or administrative appropriateness per established guidelines to the Care Management Physician Advisor and/or Care Management Leadership. Identify potential and actual care progression concerns for incoming patients, and route concerns to the appropriate care team members.
5. Customer Service- Identify and escalate barriers to efficient, effective, patient-centric and customer-friendly Transfer Center Operations. Demonstrates excellent customer service skills. Use service recovery scripting and techniques to repair missed expectations when possible. Demonstrate flexibility and professionalism in a dynamic environment with frequent re-ordering of priorities and assignments. Uses critical thinking skills to evaluate and prioritize rapidly changing demands, working collaboratively to best accomplish the team's mission.
6. Documentation- Document activities, events, and information per standards in established software systems in a timely, accurate, and complete manner. Identifies Avoidable Delays and documents causes for delay consistent with department standards. Uses established policies and processes to handle, discuss, and transmit protected health information in manner consistent with privacy and compliance expectations and policies. Uses departmental guidelines and job aids to perform work in an accurate, compliant manner consistent with known and written expectations and work rules.

Other information:
Education Requirements:
Bachelor's degree in Nursing
Licensure/Certification Requirements:
Must be licensed to practice registered nurse in the state of North Carolina
Professional Experience Requirements:
Three (3) years of inpatient care experience required
Knowledge/Skills/and Abilities Requirements:
Highly organized professional with astute clinical knowledgeGreat attention to detail, and critical thinking skillsAdaptable to frequent changeCompliant with regulatory and departmental guidelines and policies

Legal Employer: STATE

Entity: UNC Medical Center

Organization Unit: UNCH Patient Logistics Center

Work Type: Full Time

Standard Hours Per Week: 36.00

Salary Range: $41.45 - $59.58 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Onsite

Work Schedule: Rotating

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.