Utilization Manager – Behavioral Health

Emploi pas sur LinkedIn

🕒 il y a 5 jours

🌲 North Carolina – Distant

🌲 North Carolina – Remote

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 13%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Duke Careers

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1924

💼 Conseil

🏥 Santé

📚 Éducation

Consulting • Healthcare • Education

Duke Careers est une plateforme connectée à l'héritage riche de l'université de Duke, fondée en 1924. Elle vise à célébrer le centenaire de l'université de Duke tout en fournissant des ressources, des récits et des interviews qui reflètent l'histoire de l'université, ses réalisations actuelles et ses aspirations futures. Un des principaux axes de Duke Careers est d'interagir avec les anciens élèves et la communauté, mettant en avant l'impact transformateur de l'éducation et du leadership au sein de l'université.

Description

• Assess accuracy of patient class/status assignments based on clinical condition, physician intent, utilization review outcomes, rules, and regulatory requirements • Support medical chart audits through accurate, timely, and informative clinical review documentation • Support denials management and work to overturn threatened denials • Validate authorizations for bedded patients and commercial initiatives within contractual timeframes • Manage concurrent cases through resolution and conduct initial and continued-stay reviews • Review records for medical necessity and collaborate with physicians and care teams • Establish and communicate estimated length of stay and expected discharge dates using GMLOS • Apply evidence-based clinical review screening criteria and refer failed cases to Physician Advisors or appeals • Facilitate denial mitigation and peer-to-peer conversations • Collaborate with case managers, clinical social workers, physicians, and care teams on discharge planning and utilization management • Confirm orders reflect billing patient status and partner with Physician Advisors, compliance, and revenue cycle teams • Educate physicians and healthcare teams on utilization review and compliance processes • Provide feedback to improve payer negotiations • Maintain relationships and communication with internal and external customers • Participate in a hospital committee • Collaborate on quality and performance improvement, resource utilization, patient flow, capacity management, and clinical cost reduction • Complete retrospective medical necessity reviews and written appeals for regulatory agency and Medicare Advantage audits • Provide education and feedback to Utilization Managers and providers • Proactively screen and assess high-risk, potential readmission, and admitted patient encounters in the emergency department • Facilitate community referrals, post-discharge arrangements, and transitions from the ED to inpatient care

🎯 Exigences

• BSN required • Minimum of three years recent acute clinical practice or related health care experience • Current or compact RN licensure in North Carolina required • BLS certification required • Requires Case Management Certification (ACM, CCM or ANCC) within 2 years of hire • Basic computer proficiency • Ability to become proficient in navigating and interpreting an electronic health record • Ability to work effectively in a self-directed role and multitask • Ability to solve complex issues daily • Excellent written and verbal skills • Basic proficiency in Microsoft Word, PowerPoint, and Excel • Ability to work 40 hours and every other weekend

🏖️ Avantages

• Relocation Assistance (based on eligibility) • Duke University Health System is designated as a Magnet organization • Opportunity to work with a health system with 6,000+ registered nurses • Equal employment opportunity and commitment to diversity, inclusion, collaboration, innovation, creativity, and belonging • Reasonable accommodation support available