Utilization Review Case Manager RN

Duration: 13 weeks
Shift: Day Shift 8-5

Guaranteed Hours a week: 40

Start: As soon as credentialed

Job ID: 262319

Summary

Conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed on a nursing unit, to include Inpatient admissions, patients receiving Observation services and Outpatients in a Bed. Identifies delays in care. Documents and communicates findings with the care team and the payor, when necessary.

Essential Duties and Responsibilities

• Supports and promotes the mission and values of Covenant Health Ministry.
• Conducts admission, continued stay, and retrospective medical necessity reviews using health system approved criteria.
• May communicate with payor representatives regarding patients’ level of care and regarding plans for discharge.
• Responsible for communicating and collaborating with internal departments (such as, patient registration, patient accounts and others), as appropriate, to verify payer source as soon as possible upon the decision that the patient is to receive services.
• Perform ongoing evaluation and critical analysis of the patient’s progress to ensure that the patient’s Hospital needs are being delivered in the most appropriate setting and in a timely manner.
• Seeks peer assistance and/or provides consultation regarding complex cases and/or cases that have deviated from the initial plan of care.
• Facilitates education of the interdisciplinary team related to the individual patient case management goals, InterQual criteria and coverage determinations, multi-system disease processes, and payor criteria.
• Identifies opportunities for improvement in processes and quality of care and communicates findings to the director of the department.
• Maintains current knowledge of DNV & CMS regulations

Job Requirements

Job Knowledge and Skills

• Ability to manage time wisely and focus on tasks without distraction
• Ability to work autonomously in an organized manner
• Strong organizational and time management skills
• Professional skills in human relations and teamwork
• Excellent communication skills are needed.
• Good computer skills are needed
• Ability to work remotely as needed

Education and Experience

• Registered Nurse licensed in New Hampshire required
• Minimum of five years broad clinical experience preferred
• Case management and/or Utilization Management experience is preferred
• Certification as CCM or ACMA-RN preferred
• EPIC EMR preferred

An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements.

Working Conditions/Physical Demands

Must possess the physical and mental abilities to perform the tasks normally associated with this position that involves a combination of sitting, standing, walking, bending, stooping, and reaching. Occasional lifting/carrying up to 25 lbs. Some stress related to high level of responsibility for quality care.

Americans with Disabilities Statement

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Covenant Health reserves the right to modify position duties at any time, to reflect process improvements and business necessity

Should you be interested, let's discuss this briefly at your earliest convenience and please feel free to contact me at 703-652-7170, my name is Ailyn, I am available from Mon to Fri at 9a-6p EST.

Who We Are?

Since 2001 InfiCare has been providing contract and direct hire staffing services to its clients across the US.

Click below links to review some of the best workplace awards won by InfiCare:

https://www.greatplacetowork.com/certified-company/7037388 https://www.inc.com/profile/inficare

Job Types: Full-time, Contract

Pay: $65.00 - $67.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Health insurance

Healthcare setting:

• Hospital

Schedule:

• 5x8
• 8 hour shift
• Day shift

Application Question(s):

• Are you fully covid vaxxed?

Education:

• Bachelor's (Preferred)

Experience:

• Case management and/or Utilization Management: 2 years (Required)
• InterQual: 2 years (Required)
• Epic: 1 year (Preferred)
• broad clinical: 5 years (Required)

License/Certification:

• BLS Certification AHA (Required)
• CCM or ACMA-RN in NH (Preferred)
• RN license in the state of NH (Required)

Work Location: In person

Salary : $65 - $67