Case Manager – Utilization Review Specialist

🔥 17 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Quorum Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2016

👥 B2C

B2C

Quorum Health is an operator of general acute care hospitals that owns or operates 12 hospitals across nine U. S. states. The company partners with local providers and subsidiaries to deliver inpatient and community-based healthcare services, focusing on quality, safety, and supporting local economies and workforce development. Quorum Health emphasizes community investment, hospital administration, and empowering local teams to provide patient-centered care.

📋 Description

• 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

🎯 Requirements

• 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.

🏖️ Benefits

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