Manager, Inpatient and Post Acute Services

Vaga não está no LinkedIn

🕒 Agosto 25

🌲 North Carolina – Remoto

🌲 North Carolina – Remote

💵 $91.587 - $160.277 / ano

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

👻 Score fantasma 0%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

PacificSource Health Plans

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1933

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A PacificSource Health Plans é uma provedora de saúde que oferece uma gama de soluções de seguros de saúde, incluindo planos para indivíduos, famílias e empregadores. Suas ofertas incluem planos para Medicare e Medicaid, cobertura odontológica e serviços administrativos para grupos pequenos e grandes. Comprometida com o cuidado dos membros, a PacificSource enfatiza o atendimento ao cliente e fornece vários recursos para a gestão da saúde, incluindo suporte à saúde mental e programas de bem-estar.

Descrição

• Oversee daily utilization management operations for inpatient services, including clinical review, authorization, and concurrent review • Ensure timely level-of-care determinations align with clinical guidelines and regulatory requirements • Collaborate with hospital case managers, providers, and interdisciplinary teams on safe, cost-effective discharge plans • Monitor and analyze inpatient length of stay, readmissions, KPIs, and turnaround times • Oversee utilization review for skilled nursing facilities, home health, long-term acute care, and other post-acute settings • Establish transitions of care with post-acute providers to reduce preventable readmissions • Apply evidence-based protocols to confirm medical necessity and manage post-acute cost-effectiveness • Lead DSNP utilization management while integrating Medicare and Medicaid requirements • Coordinate with care teams regarding DSNP members and social determinants of health • Ensure compliance with state and federal regulations, contractual obligations, authorizations, and appeals • Develop and update utilization management policies and procedures • Prepare for and manage internal and external UM and DSNP audits • Support the UM Director with program development and department initiatives • Directly supervise inpatient, post-acute, and DSNP review staff • Recruit, train, mentor, evaluate, and develop UM personnel • Develop and monitor the annual department budget • Lead Lean process improvement using visual boards and daily huddles • Participate in manager/supervisor meetings and strategic internal and external committees • Develop metrics and present monthly/quarterly dashboards and actionable reports to senior leadership • Serve as backup to the Director of Utilization Management • Follow privacy policy and HIPAA requirements; perform other duties as assigned

🎯 Requisitos

• Minimum of seven (7) years of clinical experience • Minimum of 3 years of direct health plan experience in case management, utilization management, or disease management • Prior supervisory or management experience • Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses • Certified Case Manager Certification accredited by CCMC preferred • Thorough knowledge of medical procedures, diagnoses, care modalities, procedure codes, ICD-9 & 10, and CPT codes • Knowledge of health insurance and State of Oregon mandated benefits • Knowledge of managed care products and third-party liability (TPL) • Ability to develop, review, and evaluate utilization and case management reports • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to perform physical requirements including stooping, bending, extended sitting/standing, repetitive typing/sorting/filing, and light lifting/carrying • Approximately 10% travel required

🏖️ Benefícios

• Continuing education events • Professional development opportunities • Equal opportunity and diversity-focused work environment