Utilization/Case Management RN

Roanoke, VA, US, 24014

Job Summary

Your accomplishments and expertise are noteworthy. They’re worth taking to the next level at Carilion Clinic, a Joint Commission-accredited organization that has earned distinguished accolades for clinical excellence, including Level 3 Patient-Centered Medical Home recognition from the National Committee for Quality Assurance.
 
A regional leader based in Roanoke, Virginia, our community-based healthcare network includes seven hospitals‐including a U.S. News & World Report Top 10 hospital and two Magnet®-designated hospitals‐multi-specialty physician practices, and affiliations with prestigious academic medical institutions. Note the worthy advantages of supportive leadership, shared decision-making, state-of-the-art technological resources, inter-professional teams, innovative learning, and advancement potential.
 

This position requires the ability to work independently and exercise sound, clear judgment in interactions with physicians, payors, patients/families, internal CMC departments, and external resources.  This position requires strong analytical, PC, organizational, and time management skills as evidenced by a capacity to prioritize multiple tasks daily.  The position requires and understanding of physical/physiological characteristics of illness and/or impairment and the ability to extrapolate the information to a POC, as well as articulate the POC and question interventions as appropriate.

 

Collaborates/communicates with external payor nurse reviewers.

 

Understands and is compliant with CMC and CMS process regarding all patient rights documentation and options regarding hospital stay.

 

Provides informal education to CMC health care and medical staff regarding all payor and CMS rules and requirements.

 

Excellent interpersonal, verbal and written communication and negotiation skills are a requirement, as well as a clear understanding of the SOP within CM/UM and managed care.

Minimum Qualifications

Education: Graduate of professional school of nursing required. Bachelor's Degree in Nursing preferred.

Experience: Minimum of three (3) years to five (5) years' experience in clinical healthcare setting with direct patient care responsibilities reflecting planning, coordination, delivery of needed services such as education, discharge planning and utilization management required.

Licensure/Certification: Current licensure in Virginia as Registered Nurse required. Case Management Certification preferred.

Other: Strong oral and written communication skills as well as effective interpersonal skills. Must be effective at teaching individuals from all socio-economic and cultural backgrounds. Must have ability to work without close supervision and demonstrate effective organizational abilities.  Strong Microsoft Excel skills.  

Our Values

Below are our core values that we strive to embody and expect of all our team members:

CommUNITY:  Working in unison to serve our community, our Carilion family and our loved ones.

Courage:  Doing what’s right for our patients without question.

Commitment:  Unwavering in our quest for exceptional quality and service.

Compassion:  Putting heart into everything we do.

Curiosity:  Fostering creativity and innovation in our pursuit of excellence.

 

 

Requisition Number: 14249 
Employment Status: Full time 
Location: CRMH - Carilion Roanoke Memorial Hospital 
Shift: Day/Night 
Shift Details: 4-10 hour shifts, Tuesday - Friday, 1pm - 11:30pm, with occ. weekend shifts
Recruiter: DANA E JOHNSON 
Recruiter Phone: 540-983-4006 
Recruiter Email: dejohnson@carilionclinic.org 

 

ABOUT CARILION:
As a not-for-profit organization, we pride ourselves on investing in our employees and the communities we serve. 
 

Our employees strive to provide quality care in serving over 1 million residents in Virginia while living and growing their careers in the country's most livable cities and towns. 
 

Headquartered in Roanoke, Va., Carilion Clinic is a robust system of small and large award-winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
 

Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
 

Carilion Clinic is a drug-free workplace.

 

Posting Notes:


Nearest Major Market: Roanoke

Job Segment: Neurology, Medical, Orthopedic, Physiology, Nursing, Healthcare

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