Case Manager - Utilization Review

Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here .Are you passionate about making a difference in individuals' lives? Do you want to be part of an innovative team dedicated to providing exceptional care? If so, we invite you to join our team at the Precourt Healing Center, our new state-of-the-art behavioral health inpatient center set to open soon. We believe in treating the whole person addressing their physical, emotional, and psychological needs. About Us Striving to be the model of integrated and exceptional behavioral health treatment, research, education, and innovation by sustainably implementing an accessible and effective Behavioral Healthcare model that delivers, supports, and promotes a full continuum of care across our Mountain Communities. Why Join Us? Innovative Care Model : Join a cutting-edge approach to behavioral health that integrates the latest research and therapies. Collaborative Environment : Work alongside a dedicated team of professionals who share your commitment to excellence and compassion. Professional Growth : We are committed to your development with ongoing training, education, and career advancement opportunities. State-of-the-Art Facility : Utilize the best tools and resources in a newly designed, modern healthcare setting. Meaningful Impact : Make a real difference in the lives of individuals and families, contributing to their journey towards recovery and wellness. About the opportunity : Coordinates with clinical care team and reviews documentation to support Providers in identifying appropriate patient status. Collaborates with third party payers to ensure correct reimbursement. Maintains compliance with Centers for Medicare & Medicaid Services (CMS) regulations. Collaborates with clinical care team and patient financial services regarding denials.What you will do : Monitors for appropriateness of admission, continued stay, and readiness for discharge based on medical necessity as evidenced by appropriate documentation. Demonstrates medical necessity using InterQual criteria. Maintains continuous and effective communication with Providers to ensure complete documentation reflecting medical necessity to support appropriate patient status orders and compliance with CMS regulations as related to utilization management. Collaborates with third party payers by providing timely clinical documentation and seeking authorization as needed in partnership with Insurance Verification. Facilitates appeals based on documented medical necessity in partnership with attending Providers. Collaborates with denials management team to navigate appeals process. Participates in internal auditing, data tracking and reporting through the Utilization Review Committee to ensure best practice. Supports the needs of the Case Management department and the organization within scope of practice, as needed. Role models the principals of a Just Culture and Organizational Values. Must be HIPAA compliant. This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.What you will need : Experience : One-year recent experience in acute care hospital Utilization Review or equivalent, required. License(s) : Licensed as a Registered Nurse in the state of Colorado or from a valid compact state, required Certification(s) : N / A Computer / Typing : Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Must have working knowledge of the English language, including reading, writing, and speaking English.Education : Associate's or Bachelor's degree in nursing, required. Benefits at Vail Health (Full Time) Include : Competitive Wages & Family Benefits : Competitive wages Parental leave (4 weeks paid) Housing programs Childcare reimbursement Comprehensive Health Benefits : Medical Dental Vision Educational Programs : Tuition Assistance Existing Student Loan Repayment Specialty Certification Reimbursement Annual Supplemental Educational Funds Paid Time Off : Up to five weeks in your first year of employment and continues to grow each year. Retirement & Supplemental Insurance : 403(b) Retirement plan with immediate matching Life insurance Short and long-term disability Recreation Benefits, Wellness & More : Up to $1,000 annual wellbeing reimbursement Recreation discounts Pet insurance Pay is based upon relevant education and experience per year.Yearly Pay : $93,704 - $132,350.40 USD

Salary : $93,704 - $132,350