Utilization Manager

Emploi pas sur LinkedIn

🕒 il y a 19 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 against clinical condition, physician intent, utilization review outcomes, rules, and regulatory requirements • Support medical chart audits through accurate, timely clinical review documentation supporting medical necessity and level of care • Support denials management and work to overturn threatened denials • Validate payer authorization 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 to validate information • Establish and communicate estimated length of stay and expected discharge dates using GMLOS • Apply evidence-based clinical review criteria and refer failed criteria to the Physician Advisor or appeals process • 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 • Provide education to physicians and healthcare teams on utilization review and compliance • Participate in negotiations with payors by providing feedback • Maintain relationships with internal and external Duke Health customers • Participate in a hospital committee • Support quality and performance improvement involving resource utilization, care delivery, patient flow, capacity management, and clinical cost reduction • Complete retrospective medical necessity reviews for specified Medicare, observation, billing, and denial cases • Prepare written appeals for post-bill regulatory agency and Medicare Advantage medical necessity audits when appropriate • Provide education and feedback to Utilization Managers and providers • Proactively screen and assess high-risk, potential readmit, and admitted patient encounters in the emergency department • Collaborate with ED treatment teams to prevent inappropriate admissions and facilitate community referrals and post-discharge arrangements • Support transitions from the emergency department 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 the state of North Carolina • 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 collaborate with physicians, staff, and healthcare team members

🏖️ Avantages

• Relocation Assistance (based on eligibility)