ACO/UR Review Nurse Specialist - Full Time

Full time position, Monday – Friday 8 am – 4:30 pm.
This position is split between Utilization Review (UR) within hospital Case Management and our ACO program.
This position will be responsible for facilitating review of ACO data to identifying and address opportunities for improvement, working together with the ACO Specialist.
This is a collaborative effort to ensure we are meeting ACO goals, closing care gaps and attaining quality initiatives goals.
Responsible for working with the hospital Case Managers to ensure patient hospital admissions are appropriate and managed care insurance approvals are obtained in a timely fashion.
This position will utilize available data to determine areas that can attain higher levels of revenue and facilitate obtaining that revenue.
Current RN licensure and 5 years of nursing experience required.
Prior ACO, clinic or case management experience required.
Knowledge of prior-authorization process and/or use of MCG/InterQual software preferred.
Must possess excellent communication and time management skills.
Must possess computer skills and working knowledge of Office Word and Excel.