RN - Utilization Management

Piedmont Healthcare is seeking a compassionate and highly skilled Registered Nurse (RN) for our Utilization Management department. As a member of our team, you will play a crucial role in ensuring the delivery of quality care to our patients while also maintaining cost-effective practices. We are looking for a dedicated individual who is passionate about utilizing their clinical expertise to promote efficiency and excellence in healthcare. If you are a driven and detail-oriented RN with experience in utilization management, we encourage you to apply for this exciting opportunity.

1. Conduct utilization management activities in compliance with established policies and procedures.
2. Utilize clinical expertise to assess patient needs and ensure appropriate utilization of healthcare services.
3. Participate in the development and implementation of utilization management programs and initiatives.
4. Collaborate with healthcare providers and interdisciplinary teams to promote cost-effective and quality care.
5. Review patient medical records and other relevant information to determine medical necessity and appropriateness of care.
6. Communicate with insurance companies, healthcare providers, and patients to obtain necessary authorizations for services.
7. Monitor and analyze utilization data to identify areas for improvement and develop strategies to optimize resource utilization.
8. Educate patients and families on their healthcare options and assist in coordinating care.
9. Document all utilization management activities accurately and in a timely manner.
10. Ensure compliance with all regulatory requirements related to utilization management.
11. Participate in performance improvement activities to enhance the effectiveness of the utilization management process.
12. Remain up-to-date on industry changes and trends related to utilization management.
13. Serve as a resource and provide guidance to other healthcare professionals on utilization management processes.
14. Maintain confidentiality of patient information and adhere to HIPAA regulations.
15. Adhere to ethical and professional standards of practice.

According to JobzMall, the average salary range for a RN - Utilization Management in Atlanta, GA, USA is between $70,000 to $90,000 annually. This may vary depending on factors such as years of experience, level of education, and specific job duties.

A private, not-for-profit organization with 800 locations serving 2.5 million patients across Georgia, Piedmont is transforming healthcare, creating a destination known for the best clinicians and a one-of-a-kind experience that always puts patients first. Today, more than 110 years since it was founded, Piedmont is known as a leading health system in treatment of heart disease, organ transplantation and cancer care with 11 hospitals, 27 urgent care centers, 28 Piedmont QuickCare locations, 555 Piedmont Clinic physician practice locations and more than 2,300 Piedmont Clinic members.