UR Specialist- Care Management (Remote)
Job title: UR Specialist- Care Management (Remote) in Georgia at Phoebe Putney Health System
Company: Phoebe Putney Health System
Job description: Job Number: 31666Location: Remote - GeorgiaStreet Address: Remote AddressCity, State: Remote, GeorgiaZip Code: 31701Department: PPMH CARE MANAGEMENTShift: DaysJob Type: Full timePosted Date: 2025-04-28Job Description Summary:Description:JOB SUMMARY
The primary responsibilities of the RN UR Specialist include performing activities related to insurance company notifications, obtaining certifications and authorizations related to Utilization review duties in Care Management. Timely communication of clinical information and updates will be provided to the insurance companies as requested or required by contract or federal and state regulations in support of medical necessity justification and hospital billing and payment for patient care and services rendered. He/she will liaison with third party payers regarding UR requirements, authorization or denial matters, and will assist with complext authorization needs impacting patient transition planning. Proactive communication with Care Manager and Social Work staff will foster coordination and a team approach for key care managment functions and meeting patient needs. Will notifiy Care Managers of potential denials and communicate with patient physician and payer medical director for peer to peer discussions.GENERAL REQUIREMENTS
Adheres to the hospital and departmental attendance and punctuality guidelines
Performs all job responsibilities in alignment with the core values, mission and vision of the organization
Performs other duties as required and completes all job functions as per departmental policies and procedures
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs)
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
WORKING CONDITIONS
General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.
May be exposed to high noise levels and bright lights.
May be exposed to limited hazardous substances or body fluids, or infectious organisms.
May be required to change from one task to another of different nature without loss of efficiency or composure.
Periods of high stress and fluctuating workloads may occur.
May be scheduled as needed including overtime.
EDUCATION REQUIREMENTS
2 year / Associate Degree in Nursing (Required)
4 year / Bachelor's Degree in Nursing (Preferred)
EXPERIENCE REQUIREMENTS
4 - 5 years Recent and relevant acute clinical care experience (Required)
1 - 2 years Utilization review experience in a hospital, managed care or physician office practice setting. (Required)
CERTIFICATIONS AND LICENSURES
Required Certifications/Licensures: Registered Nurse (RN) with current Georgia license
Preferred Certifications/Licensures: CCM or CPUR
GENERAL SKILLS
Interpersonal Skills
Customer Relations
Mathematical
Analytical
Grammar / Spelling
Read / Comprehend Written Instructions
Follow Verbal Instructions
Transcription
Microsoft Office Suite
General Clerical Skills
Proficient computer typing skills, use of electronic health record and internet.
Able to generate basic spreadsheets and word documents.
Highly organized and detail oriented with ability to meet tight timeframes and time sensitive actions.
Effective verbal and written communication skills
PHYSICAL REQUIREMENTS
Have near normal vision - Clarity of vision (both near and far), ability to distinguish colors
Have good - manual dexterity and eye-hand-foot coordination
PHYSICAL DEMANDS
Standing - Frequently within shift (34-66%)
Walking - Frequently within shift (34-66%)
Sitting - Frequently within shift (34-66%)
Climbing - Occasionally within shift (1-33%)
Bending/Stooping - Frequently within shift (34-66%)
Twist at waist - Frequently within shift (34-66%)
Pushing/Pulling - Frequently within shift (34-66%)
Lift/carry up to 20 lbs - Frequently within shift (34-66%)
Lift/carry
20 lbs with assistance - Occasionally within shift (1-33%) * Reaching above shoulder - Frequently within shift (34-66%)Phoebe Putney Health System employees are prohibited from working as Remote employees in the following states:
California
Colorado
Connecticut
Hawaii
Maryland
Massachusetts
Michigan
Nevada
New Jersey
New York
Oregon
Rhode Island
Vermont
Washington
Washington D.C.
Expected salary:
Location: Georgia
Apply for the job now!
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Company: Phoebe Putney Health System
Job description: Job Number: 31666Location: Remote - GeorgiaStreet Address: Remote AddressCity, State: Remote, GeorgiaZip Code: 31701Department: PPMH CARE MANAGEMENTShift: DaysJob Type: Full timePosted Date: 2025-04-28Job Description Summary:Description:JOB SUMMARY
The primary responsibilities of the RN UR Specialist include performing activities related to insurance company notifications, obtaining certifications and authorizations related to Utilization review duties in Care Management. Timely communication of clinical information and updates will be provided to the insurance companies as requested or required by contract or federal and state regulations in support of medical necessity justification and hospital billing and payment for patient care and services rendered. He/she will liaison with third party payers regarding UR requirements, authorization or denial matters, and will assist with complext authorization needs impacting patient transition planning. Proactive communication with Care Manager and Social Work staff will foster coordination and a team approach for key care managment functions and meeting patient needs. Will notifiy Care Managers of potential denials and communicate with patient physician and payer medical director for peer to peer discussions.GENERAL REQUIREMENTS
Adheres to the hospital and departmental attendance and punctuality guidelines
Performs all job responsibilities in alignment with the core values, mission and vision of the organization
Performs other duties as required and completes all job functions as per departmental policies and procedures
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs)
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
WORKING CONDITIONS
General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.
May be exposed to high noise levels and bright lights.
May be exposed to limited hazardous substances or body fluids, or infectious organisms.
May be required to change from one task to another of different nature without loss of efficiency or composure.
Periods of high stress and fluctuating workloads may occur.
May be scheduled as needed including overtime.
EDUCATION REQUIREMENTS
2 year / Associate Degree in Nursing (Required)
4 year / Bachelor's Degree in Nursing (Preferred)
EXPERIENCE REQUIREMENTS
4 - 5 years Recent and relevant acute clinical care experience (Required)
1 - 2 years Utilization review experience in a hospital, managed care or physician office practice setting. (Required)
CERTIFICATIONS AND LICENSURES
Required Certifications/Licensures: Registered Nurse (RN) with current Georgia license
Preferred Certifications/Licensures: CCM or CPUR
GENERAL SKILLS
Interpersonal Skills
Customer Relations
Mathematical
Analytical
Grammar / Spelling
Read / Comprehend Written Instructions
Follow Verbal Instructions
Transcription
Microsoft Office Suite
General Clerical Skills
Proficient computer typing skills, use of electronic health record and internet.
Able to generate basic spreadsheets and word documents.
Highly organized and detail oriented with ability to meet tight timeframes and time sensitive actions.
Effective verbal and written communication skills
PHYSICAL REQUIREMENTS
Have near normal vision - Clarity of vision (both near and far), ability to distinguish colors
Have good - manual dexterity and eye-hand-foot coordination
PHYSICAL DEMANDS
Standing - Frequently within shift (34-66%)
Walking - Frequently within shift (34-66%)
Sitting - Frequently within shift (34-66%)
Climbing - Occasionally within shift (1-33%)
Bending/Stooping - Frequently within shift (34-66%)
Twist at waist - Frequently within shift (34-66%)
Pushing/Pulling - Frequently within shift (34-66%)
Lift/carry up to 20 lbs - Frequently within shift (34-66%)
Lift/carry
20 lbs with assistance - Occasionally within shift (1-33%) * Reaching above shoulder - Frequently within shift (34-66%)Phoebe Putney Health System employees are prohibited from working as Remote employees in the following states:
California
Colorado
Connecticut
Hawaii
Maryland
Massachusetts
Michigan
Nevada
New Jersey
New York
Oregon
Rhode Island
Vermont
Washington
Washington D.C.
Expected salary:
Location: Georgia
Apply for the job now!
Apply Now