Case Manager – Utilization Review Specialist

🕒 Junho 11

🎸 Tennessee – Remoto

🎸 Tennessee – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Quorum Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2016

👥 B2C

B2C

A Quorum Health é uma operadora de hospitais gerais de cuidados agudos que possui ou opera 12 hospitais em nove estados dos EUA. A empresa faz parceria com prestadores de serviços locais e subsidiárias para oferecer serviços de saúde baseados em internação e comunidade, com foco na qualidade, segurança e apoio às economias locais e desenvolvimento da força de trabalho. A Quorum Health enfatiza o investimento na comunidade, administração hospitalar e o empoderamento das equipes locais para fornecer um cuidado centrado no paciente.

Descrição

• Assumes responsibility and accountability for admission and concurrent reviews • Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility • Compares inpatient medical records to established criteria • Abstracts data from records and maintains statistics • Determines patient review dates according to established diagnostic criteria • Coordinates first, second and third level appeals • Manages appeals to ensure timely submissions • Forms professional relationships with payer appeals and utilization departments • Prepares and presents information on appeals to applicable committees

🎯 Requisitos

• Current state-issued RN license • Significant experience in the healthcare field including a minimum of five years as a clinical nurse in an acute care setting • At least five to seven years of experience in case management, discharge planning, and/or utilization review preferred • Knowledge of regulatory and payer requirements for Case Management Activities • Ability to critically evaluate and make decisions about highly difficult cases • Ability to maintain confidentiality of patient data and medical records in compliance with HIPAA regulations • Excellent oral and technical writing and typing skills.

🏖️ Benefícios

• Health insurance • Paid time off • Flexible work arrangements • Professional development opportunities