UM Case Manager – Utilization Management

🔥 0 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏱ Part Time

🟢 Junior

🟡 Mid-level

👔 Manager

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McLeod Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded over a century ago

⚕️ Healthcare Insurance

Healthcare Insurance

McLeod Health is a healthcare organization providing a wide range of medical services in multiple locations, including Florence, Cheraw, Clarendon, Dillon, Loris, Seacoast, and Carolina Forest. It offers specialized care across various departments such as behavioral health, cancer treatment, cardiology, orthopedics, neurology, emergency and trauma services, as well as children's and women's healthcare. McLeod Health is committed to community involvement and offers wellness programs, occupational health, and patient support services. The organization is recognized for its dedication to patient safety and advanced healthcare services, including telehealth options, rehabilitation, and a variety of outpatient services. It also supports medical education through physician employment and residency programs.

📋 Description

• Coordinates/facilitates patient care progression throughout the continuum of care. • Assures the plan of care and services provided are patient focused, high quality, efficient, and cost effective. • Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered. • Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas. • Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors. • Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form. • Ensures that all payer communication is documented for the care team as well as billing. • Ability to cover various populations across the organization in relation to Utilization Review. • Performs all other duties as requested by Case Manager Supervisor and/or Director.

🎯 Requirements

• 1-2 years of recent acute care hospital experience required • Data entry/computer experience required • Registered Nurse

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off