RN Coordinator - Utilization Review Atrium Health Clinical Care Management Remote PRN Days

Atrium Health is one of the nation’s leading healthcare organizations, connecting patients with on-demand care, world-class specialists and the region’s largest primary care network. A recognized leader in healthcare delivery, quality and innovation, our foundation rests on providing clinically excellent and compassionate care. We’ve been serving our community since 1940, when we opened our doors as Charlotte Memorial Hospital. Since then, our network has grown to include more than 40 hospitals and 900 care locations ranging from doctors’ offices to behavioral health centers to nursing homes. Our focus: Delivering the highest quality patient care, supporting medical research and education, and joining with partners outside our walls to keep our community healthy.

Assists and collaborates with multidisciplinary team in providing specific clinical information that meets expectations of third-party payors; responsible for timely provision/flow of clinical information to/from third party payor and multidisciplinary team to ensure certification/approval of inpatient services. Provides clinical expertise/knowledge support to the payor specialist(s). Reviews clinical information prior to sending to payor as needed to ensure information meets acute clinical care guidelines.

Identifies clinical, financial, and psychosocial needs of patients/families and provides leadership and guidance to the multidisciplinary team to develop an individualized plan of care. Ensures essential information and necessary forms are placed in the revenue cycle tool and available for the revenue cycle team and other disciplines. Provides necessary documentation and information to third party administrators as needed. Performs admission and concurrent reviews. Applies clinical guidelines during Admission and Concurrent reviews and identifies potential third-party denials. Works with multidisciplinary team to identify and implement alternative plans of care. Initiates and request authorizations for post-acute care as needed to facilitate care coordination. Refers pertinent cases to the Medical Director, Service Director, and/or Physician Advisor in a timely manner. Collaborates as needed with the physician to plan and implement medical and multidisciplinary plan(s) of care, utilizing clinical pathways when appropriate and available. Identify and escalate barriers and problems to the multidisciplinary team and leadership for intervention and resolution. Develops and maintains accurate case records of assigned cases. Documents in the patient's medical record according to department and facility standards.