Clinical Resource Coordinator and Utilization R...

Overview

Penn Medicine is dedicated to patient care, research, and education. This REMOTE RN role focuses primarily on utilization review (UR). We are seeking individuals who have between 3 to 5 years of UR experience and can work independently with strong attention to detail. Candidates with established relationships with payors and MD advisers are welcomed.

Responsibilities

• Utilization management activities: monitor appropriate use of internal resources, communicate with interdisciplinary care team and Physician Advisor
• Discharge planning: timely coordination of home care, DME, placements, hospice, community resources, transportation
• Quality data collection and risk management referrals
• Collaborate with patient and family to assure provision of choice in post-hospital setting
• Educate patients/customers regarding scope and limitations of health care/insurance benefits
• Respect patient privacy and confidentiality
• Communicate expected discharge time frame
• Stay current with new providers, technologies, treatment modalities, and resources
• Provide care that accounts for the needs of older adults in a developmentally appropriate manner
• Discharge planning: assess patient and family social, emotional, and discharge needs; develop and facilitate a plan; document delays and communicate with the care team
• Assist patients in transitioning to the next level of care with transfers and referrals to community resources
• Participate in daily interdisciplinary meetings and drive accountability
• Adhere to guidelines to satisfy third-party payer requirements; educate team on appropriate documentation for IS/SI
• Ensure timely patient flow and appropriate care settings
• Document review activity in Canopy; track patient days and case status
• Complete readmission screening as indicated
• Contribute to quality improvement and risk management initiatives
• Utilize technology and systems (e.g., MedView, On Base, SafetyNet, Sunrise, Outlook, Canopy, CERME, ECIN) in daily practice

Qualifications

• Registered Nurse — PA licensure required
• Bachelor of Arts or Science (required)
• 3–5 years UR experience (preferred)
• 2+ years clinical experience

Employment details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Administrative
• Industries: Wellness and Fitness Services, Hospitals and Health Care, Medical Practices

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, age, disability, marital status, familial status, genetic information, citizenship status, military status, or any other status protected by applicable law.