Utilization Management Specialist

Emploi pas sur LinkedIn

🔥 il y a 8 heures

🦬 Montana – Distant

🦬 Montana – Remote

💵 $37 - $54 / heure

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👻 Score fantôme 0%

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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Logan Health

Site WebLinkedInTous les Emplois

1001 - 5000 employés

🏥 Santé

⚕️ Assurance santé

Healthcare • Healthcare Insurance

Fondé en 1910, Logan Health offre des soins exceptionnels depuis plus de 100 ans aux communautés qu'il dessert. Bien que le principal campus médical soit situé dans le comté de Flathead, Logan Health couvre une zone de service totale comprenant 13 comtés, près de 40 000 miles carrés, et une population de plus de 600 000 personnes. Le système de santé se compose de six hôpitaux, de plus de 50 cliniques de prestataires et d'une multitude d'autres services de santé, y compris le premier service d'ambulance aérienne rurale du pays (A.L.E.R.T.).

Description

• Review all daily inpatient and observation admissions across the Logan Health system • Evaluate physician documentation and patient data to determine appropriate admission status • Reassess patients throughout their stay to ensure continued criteria for level of care are met • Collaborate with the physician UM Advisor, case management team, and insurance partners to facilitate authorizations and medical necessity reviews • Assist with scheduling and coordinating peer-to-peer physician reviews • Communicate with providers, nurses, and other stakeholders to ensure accurate documentation and smooth care transitions • Identify and address issues that could delay reviews or affect compliance • Utilize electronic medical records for documentation, review, and reporting • Coordinate and facilitate correct identification of patient status using validated criteria • Complete short stay work queue reviews and track and trend results for reporting and education • Identify process and system improvement opportunities and lead performance initiatives • Identify and resolve system process issues, delays, and obstacles affecting utilization management • Answer clinical questions related to medical necessity and patient status • Perform concurrent and retrospective reviews • Assist with insurance denial appeal letters, audit activities, and payer inquiries • Resolve utilization management and patient status issues with stakeholders • Consult appropriate disciplines and departments to expedite care and facilitate accurate documentation • Refer utilization management issues to leadership or appropriate stakeholders and monitor resolution • Participate in development, implementation, teaching, evaluation, and revision of departmental utilization management standards • Participate in orientation of new department staff • Document utilization management, quality, and risk concerns and refer them for follow-up • Work independently while collaborating with the interdisciplinary team

🎯 Exigences

• Current Montana RN License or a multi state compact license with authorization to practice nursing within the state of Montana • Bachelor’s degree in Social Work • Associate’s degree required; Bachelor’s degree preferred • Minimum of five (5) years’ acute care hospital experience required • CCM Certification preferred • Prior experience as an inpatient utilization review nurse or UM specialist preferred • Knowledge in areas of Medicare and Medicaid UM regulations, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management preferred • Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy • Excellent verbal and written communication skills including the ability to communicate effectively with various audiences • Strong computer literacy • Analytical thinking • Acute care (hospital) experience • Must currently reside in the State of Montana • Must pass pre-employment criminal background, reference, drug, health and immunizations, and physical demand screenings

🏖️ Avantages

• Four day work week • Affordable Medical Benefits package • 401(k) with generous immediate employer match • Logan Health Fitness Center Membership Discount! • A supportive, mission-driven nursing culture focused on quality, compassion and person-centered care!