Utilization Management, RN Team Leader - Certified

Job Summary:

The Utilization Review RN Team Lead Certified is a professional nurse employed by Erlanger Medical Center and is responsible for the support and adherence of day-to-day processes and responsibilities assigned to a team of Utilization Review RNs. Responsibilities include the design and implementation of an educational program based on nationally accepted best practices and organizational needs that includes training of new and existing UR nurses along with an auditing process to identify on-going educational needs. The incumbent acts as a liaison between Utilization Review staff, Case Management staff, physicians, Patient Financial Services staff and insurance representatives to ensure bedded patients are in the appropriate admission status and are approved by their payer for the care provided to them by Erlanger's clinical staff. This position is also responsible for overseeing communications between the Utilization Review RN staff and Case Management staff to identify patient's potential discharge readiness. Incumbent may also be asked to represent the department in meetings or committees where the Utilization Review Department has an impact.

This position is responsible for the assignment of and coordination of daily assignments for their team of Utilization Review RN�s and may include covering a section of patients in the event of staffing shortages. This position monitors and oversees the documentation adherence of their assigned staff to department processes and policies. They will serve as an educational resource for other Utilization Review teams, support staff, and physicians regarding insurance requirements along with being an education resource for both Milliman and InterQual criteria. This position reports to the Manager, Utilization Review.

Education:

Required: Graduate from an accredited school with an Associate's Degree in Nursing (RN).

Preferred: Graduate from an accredited school with Bachelor of Nursing (BSN), Masters of Nursing, Healthcare Administration or Business.

Experience:

Required: 10 years of nursing experience including a broad range of both clinical nursing and utilization review and/or case management experience. Demonstrated ability to work effectively with professionals in diverse disciplines. Must be computer literate and demonstrate ability to prioritize tasks and timeframes. Experience in and ability to coach, teach and manage individuals that utilize different learning mechanisms to assist them to reach their maximum potential.

Preferred: Knowledge of managed care practices and familiarity with regulatory and insurance reimbursement issues.

Position Requirement(s): License/Certification/Registration Required: Current licensure to practice nursing in the State of Tennessee (RN). Certified in Milliman and or InterQual Utilization Management or required to complete certification within one from hire date.

The Nurse Licensure Compact will not change how to obtain or renew a Tennessee license. However, the Tennessee nursing license will be a single state license for Tennessee Residents or non-compact state residents. Tennessee licensure or multistate licensure from a compact state must be obtained within three months of hire for non-Tennessee residents.

Department Position Summary:

The Utilization Review Team Lead Certified is a professional nurse employed by Erlanger Medical Center and is responsible for the oversight, support and day-to-day processes and responsibilities of a team of Utilization Review RNs. Responsibilities include the design and implementation of an educational program based on nationally accepted best practices and organizational needs that includes training of new and existing UR nurses along with an auditing process to identify educational needs, The incumbent acts as a liaison between Utilization Review staff, Case Management staff, physicians, Patient Financial services staff and insurance representatives to ensure bedded patients are in the appropriate admission status and are approved by their payer for the care provided to them by Erlanger's clinical staff. This position is also responsible for overseeing communications between the Utilization Review RN staff and Case Management staff to identify patient's potential discharge readiness. Incumbent may also be asked to represent the department in meetings or committees where the Utilization Review Department has an impact.