Utilization Management Registered Nurse
Job ID: R0040098 | Registered Nurse Professionals | Full Time | Charlottesville, VA
Under general direction, the Utilization Management RN serves as a leader resource in the Utilization Management process. They collaborate with physicians and other members of the healthcare team to promote and adhere to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission, vision, and values of UVA Medical Center.
  • Analyzes and evaluates complex medical documentation.
  • Demonstrates competence in interpretation of clinical data and the application of UM tools.
  • Collaborates with physicians and care team: attending, resident, mid-level practitioners.
  • Utilizes judgment and critical thinking in determining what cases to refer for second-level review to external physician consultants and internal UVA UR MDs.
  • Provides complete, accurate, and timely clinical data to insurance companies.
  • Utilizes judgment and critical thinking to determine if denied cases will be appealed utilizing medical, contract, and payor rules.
  • Conducts appeals with external entities and consultants.
  • Manages appealed cases, including external review and resolution for Billing.
  • Actively supports the financial mission of the department.
  • Practices according to department standards.
  • Assumes responsibility for professional development of self and contributes to and assists with the professional development of others.
  • Demonstrates leadership in the UM role.
  • In addition to the above job responsibilities, other duties may be assigned.

Position Compensation Range: $70,595.20 - $112,944.00 Annually

MINIMUM REQUIREMENTS
  • Education: Bachelor of Science in Nursing from accredited nursing program.
  • Experience: 2 years of acute care hospital experience.
  • Licensure: Licensed to practice as a registered nurse in the Commonwealth of Virginia required.

PHYSICAL DEMANDS
Job requires sitting for prolonged periods. Proficient communicative, auditory, and visual skills. Attention to detail and ability to write legibly.



COVID Vaccination Requirement and Guidelines

 

Please visit the UVA COVID-19 Job Requirements and Guidelines webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.

 

 

 

Charles Bodden
Charles Bodden
Sr. Director of Talent and Retention
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Charlottesville, VA
Charlottesville, VA 22903
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Charles Bodden
Charles Bodden
Sr. Director of Talent and Retention
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