Overview

Where you matter as much as the work you do

Join Emory Healthcare (EHC) if you’re looking for an opportunity with one of the nation's leading Atlanta hospitals in cardiology and heart surgery, cancer, neurology, and more! EHC is where those around you are dedicated to the power of teamwork, fostering an environment where you can learn, grow, and innovate with similarly passionate professionals. Work with us to improve the quality of life throughout Georgia through partnerships with the U.S. Centers for Disease Control and Prevention, Georgia Institute of Technology, and other organizations and make a bigger, greater impact than you ever thought possible.

Description

We're seeking a Registry Utilization Management Analyst responsible for reviewing each hospital admission in accordance with nationally recognized criteria and department policies to determine the medical necessity of admission and appropriate LOS. This individual will:

• Complies with established policies and procedures and implements appropriate changes to the Utilization Management process as directed.
• Provides information including thorough, accurate and timely clinical updates to comply with regulations of third party payors and federal and state regulatory agencies and to obtain approvals of LOS and facilitate accurate payment of claims.
• Issues and administers notices of non-coverage and potential of liability to clients in accordance with predetermined regulations, policies and procedures.
• Maintains an effective flow of information between the nursing units, Social Services, physicians, Medical Records, Business Office and third party payors to facilitate appropriate lengths of stay (LOS) and to ensure appropriate reimbursement and coverage.

Minimum Qualifications

• Graduate of an accredited nursing program.
• Currently licensed as a Registered Nurse in the state of Georgia.
• Two years of recent health care experience (within the past five years) and one year of experience in utilization management, quality improvement, or discharge planning.
• A bachelor's degree in nursing or related health care field preferred.

JOIN OUR TEAM TODAY! Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet® designated ambulatory practice. We are made up of 11 hospitals-4 Magnet® designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.

Additional Details

• Supporting a diverse, equitable and inclusive culture. Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members. Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. 

  ACCOMODATIONS: EHC will provide reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion.”

  PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.