Utilization/Clinical Review RN -PRN

Job Responsibilities

• Provides clinical information to insurance companies as needed for completion of pre-certification process.
• Evaluates all patients, including critical care, for appropriateness of admission type and setting.
• Initiates and facilitates physician communications relative to utilization review process.
• Reviews concurrently all inpatients, including critical care, every three days or sooner if payor requests.
• Gathers and reviews relevant medical information and documents utilization review process outcome.
• Serves as resource to Case Management for facilitation of patients moving to appropriate level of care.
• Meets productivity and quality assurance standards.
• Attends all required meetings and participates in department activities.

Requirements

• 3 years of experience in a healthcare setting; pediatrics preferred
• Bachelor of Science in Nursing
• Previous experience with MCG and/or InterQual systems
• 2 years of experience in hospital or insurance related utilization review

Qualifications

• Licensure as a Registered Nurse in the State of Georgia or Multi-State through the Enhanced Nurse Licensure Compact
• Working knowledge of financial aspects of third-party payors and reimbursement
• Effective decision-making/problem-solving skills
• Demonstration of creativity in problem-solving
• Above-average computer skills

Skills

• Basic Windows Skill Assessment at 80% or higher rating within 30 days of employment

Benefits

Some Holidays are required as well.

Pay

Commensurate with experience.

Schedule

Work Shift Variable Work Day(s) Variable Shift Start Time 6:00 AM Shift End Time 5:00 PM Worker Sub-Type PRN

About the Role

This role is PRN and requires (6) 8-hour days per month with 1 day being on the weekend. We'll be open to offering more if possible.

Training/Orientation

Training/Orientation will be 3 days/week (8-hour days) for 8-10 weeks. Onsite Orientation is needed 3-4 days for first week.

Children’s Healthcare of Atlanta

Children’s is one of the nation’s leading children’s hospitals. Every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always.

Equal Opportunity Employer

Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.