Utilization Review Case Manager - Home Care

Utilization Review Case Manager – Home Health

Full Time, Days

Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire?

• You experience satisfying and challenging work that makes a difference, every day.
• You really get to know your patients and become an integral part of their care team.
• You are provided broad independence but are also part of a cohesive interdisciplinary team.
• You get to be an important part of the community where you live.
• You have a work/life balance that can match the flexibility you need.

Benefits include:

• Employee Referral Bonuses
• Clinical CEUs
• Online LinkedIn Learning
• Extensive health, dental, and lifestyle benefits that come with being part of the renowned Dartmouth Health system

Locations:

• Fully remote work in all states except: CA, CT, MA, MD, NJ, NY, OH, RI, WY.

Visiting Nurse and Hospice for VT & NH covers more than 70 towns delivering superior nursing, rehabilitation, hospice, and personal care services with proven effectiveness, integrity, and compassion. Our only goal is to help the people in our communities. When you join Visiting Nurse and Hospice for VT & NH, you’ll become part of a dedicated team delivering outstanding home health and hospice services that enrich the lives of the people we serve.

Utilization Review Case Managers at VNH manage home care patients through assessment, planning, implementing, coordinating and evaluating care for each patient. Responsibilities include but are not limited to: appropriate treatment intervention, evaluation of outcomes, and utilization of services to ensure that patient care needs are met, while also ensuring appropriate utilization of resources.

The URCM:

• Collaborates with primary clinician, provider, patient, their family and/or the primary care givers upon admission to create a plan for patient’s care.
• Continuously reviews the patient’s plan of care and collaborates with primary clinician throughout patient’s episode to ensure the patient’s plan of care aligns with care being provided.
• Coordinates and manages the patient’s plan of care, including but not limited to: order review, resource management, measuring outcomes, and communication and collaboration with patient, caregiver and attending provider.
• Collaborates with primary clinician in identifying need for referral for interdisciplinary services.
• Utilizes key performance indicators associated with value-based purchasing, patient driven grouping models, and patient satisfaction to guide patient care and utilization.
• Completes clinical review of referrals and collaborates with the intake and referral teams.
• Demonstrates knowledge of Medicare regulations and delivers care in accordance with Medicare Condition of Participation (CoP). 
• Reviews usage of supplies and equipment in patient care. 
• Collaborates with Home Health Manager in identifying items such as: patient concerns, educational opportunities for clinicians, trends, etc.
• Escalates anticipated or actual safety concerns to appropriate leader.
• Completes chart reviews and special projects as directed by Director of Quality and Patient Safety.

Minimum Qualifications:

• Graduate of an accredited school of nursing.
• Unencumbered professional license in both VT and NH or compact.
  • RN preferred, PT considered.
• Minimum of 2 years’ experience in Home Health
• Adept at navigating the Electronic Medical Record
• Proficiency in Excel and Word systems

We would love to meet you and tell you more about this engaging and fulfilling part of our healthcare delivery system. Our recruiters can explain the different roles, our service area, the unique aspects of home and hospice care, and the many benefits we can offer your career and personal life.

Visiting Nurse and Hospice for Vermont and New Hampshire (VNH) will never require candidates to provide personally identifying information such as social security number, date of birth, street address, or banking information in order to submit an application for employment. Identifying information will only be requested after an offer of employment has been extended and accepted, for the purposes of security screening and onboarding. If you experience a request for your personal information prior to acceptance of an offer of employment, please contact VNH’s Human Resources Department immediately at 888.300.8853 or EmailHR@vnhcare.org.

As part of Dartmouth Health, Visiting Nurse and Hospice for VT & NH is an equal-opportunity employer.