RN - Utilization Management Team Lead - Greenville, NC

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944520

Vidant Medical Center

Full-Time

Regular

Vidant Health

About Vidant Health

Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.

Position Summary

The Utilization Management Team Lead provides support to the Utilization Specialists and Utilization Techs with direct oversight of the UM Manager and provides support for the day-to-day operations of the Utilization Management workflows. This is accomplished through active involvement and leadership of the care team day-to-day operation; ensuring that staff is consistent with Vidant Health policies and procedures and in compliance with contractual, state and federal guidelines. The Team Lead serves as clinical resource to staff members and providers.

Minimum Requirements

  • NC RN licensure required
  • Associates Degree in Nursing required and BSN preferred
  • If ADN prepared must have 5 + years experience in utilization management in a hospital setting or commercial payer utilization management with demonstrated detailed levels of knowledge of commercial, government payer and/or denial rules are required
  • If BSN prepared must have minimum of 3 years experience in utilization management in a hospital setting or commercial payer utilization management with demonstrated detailed levels of knowledge of commercial, government payer and/or denial rules are required
  • MCG and or InterQual experience is required
  • Knowledge, Skills & Abilities required:
    • Demonstrated ability to make independent decisions and assume responsibility
    • Strong interpersonal communication skills, verbal and written
    • Ability to communicate and work effectively with all levels of staff
    • Working knowledge and experience with PC-based applications, i.e. Word, Excel, PowerPoint, Outlook
    • Ability to function as a leader, team member and execute the desired outcomes
    • Must exhibit creative, positive problem-solving abilities
    • Ability to foster collaboration between multiple parties
    • Ability to plan, organize and effectively present ideas and concepts to groups
    • Ability to think conceptually and apply concepts in a practical application
    • Ability to assimilate information from a variety of sources, analyze information, and determines a course of action
    • Ability to consider diverse opinions and incorporate them into the decision-making process
    • Commitment to a high standard of customer service

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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