Outcomes Manager

🔥 15 hours ago

🌵 Arizona, Connecticut, +16 more states – Remote

🌵 Arizona – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🐎 Kentucky – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $79.7k - $123.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Lourdes Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Lourdes Health System is a comprehensive healthcare provider, offering a wide range of medical services including heart care, cancer care, neuroscience, orthopedics, OB/GYN, urgent care, surgery, and transplant care. It operates multiple hospitals and urgent care centers across South Jersey, providing telehealth and virtual visit options for convenient access to care. The organization is committed to community health, offering services such as mobile health units, health education, nutrition support, and free cancer screenings. Lourdes Health System aims to build trustful partnerships with patients, providing life-saving procedures and a supportive healthcare experience.

📋 Description

• Apply appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes • Act as a resource to UR Tech and AA team members to support UR and revenue cycle processes • Utilize payer-specific screening tools to assist in determining level of service and medical necessity • Consult with Physician Advisor regarding medical necessity, length of stay and appropriateness of care • Identify and manage concurrent and retroactive denials through communication with physicians, case management, multidisciplinary teams, external physician resource groups and payers • Complete clinical review and denial management documentation in case management and billing systems • Manage concurrent denial processes and refer to appropriate resources for concurrent and retrospective appeals • Prepare and facilitate audits using appropriate screening tools and documentation • Meet job-specific goals, objectives and dashboard metrics • Participate in organizational improvement activities, committees, departmental/divisional teams and community activities • Understand and apply applicable federal and state requirements • Identify and report compliance issues as appropriate

🎯 Requirements

• RN required • 3 years clinical nursing (RN) experience • 1 year UR/CM/QM experience preferred • Basic understanding of Medicare, Medicaid and managed care • Discharge planning or home health background • Excellent verbal and written communication skills • Problem solving, critical thinking and conflict resolution skills • Graduate of an accredited School of Nursing • Licensure from the State of New Jersey as a Registered Nurse • Case Management Certification required within one year of hire beginning April 1, 2015

🏖️ Benefits

• Medical/prescription insurance • Dental insurance • Vision insurance • Health and dependent care flexible spending accounts • 403(b) (401(k) subject to collective bargaining agreement) • Paid time off • Paid sick leave as provided under state and local paid sick leave laws • Short-term disability • Optional long-term disability • Colleague and dependent life insurance • Supplemental life and AD&D insurance • Tuition assistance • Employee assistance program including free counseling sessions