Utilization Review Manager - Home Care jobs in California
Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
Recently Added Utilization Review Manager - Home Care jobs
Utilization Review Case Manager
- AMFM Healthcare
-
San Juan Capistrano, CA
FULL_TIME
-
AMFM Healthcare is looking for a Utilization Review Case Manager to join our incredible team! The Utilization Review (UR) Case Manager serves as a key member of the interdisciplinary team and actively manages and directs insurance utilization throughout a client’s treatment episode, from admission to discharge.
As an effective communicator, the UR Case Manager works in solidarity with all departments including Admissions, Billing, Compliance, and Clinical Departments, and plays an active role in treatment team discussions. The UR Case Manager acts as a liaison between insurance and facility/clinical teams and coordinates effectively with discharge planners on estimated step down or discharge dates and insurance recommendations. The UR Case Manager will be responsible for their own assigned caseload. The UR Case Manager will oversee the effective coordination of services and manage issues in the following areas: admission and discharge, team conferences and plan of care communication, patient and family education when necessary, and payor relations.
The UR Case Manager will complete all initial, concurrent, and discharge reviews in a timely manner as required by insurance standards. The UR Case Manager will effectively manage and schedule peer reviews and expedited appeals with licensed clinicians to ensure minimal cost risks. The UR Case Manager will be available nights and weekends on an as needed and revolving basis and will report to the Director of Utilization Review.
About Us
After the tragic loss of a beloved son due to mental illness, A Mission for Michael (AMFM Healthcare) was created with the vision of preventing such hopelessness in the lives of others. Our mission is to provide exceptional residential mental health care that transforms lives and promotes lasting recovery.
At AMFM Healthcare, our team is composed of individuals who possess both the qualifications and the unwavering passion to deliver comprehensive care for severe mental illness. We understand the profound impact mental health struggles can have on individuals and their families, and we are dedicated to offering support, healing, and hope.
What sets AMFM Healthcare apart in the field of mental health care is our commitment to an intensive focus on clinical evidence-based treatment. We believe in the power of proven therapeutic approaches and continuously strive to integrate the latest research and advancements into our care programs. By leveraging this expertise, we aim to provide the highest quality of treatment and optimize outcomes for our residents.
As you step into our facilities, you'll immediately notice that we are different from most mental health treatment centers. We foster a welcoming and nurturing environment where individuals can find solace and embark on their journey to recovery. Our dedicated staff members prioritize personalized and compassionate care, understanding that each person's experience with mental illness is unique. We take the time to truly listen, to empathize, and to tailor our programs to meet the specific needs of each resident.
Benefits For Full Time Employees- Medical, Dental, and Vision plans through Anthem.
- FSA/HSA Accounts.
- Life/AD&D insurance through Anthem, 100% paid for by the employer.
- 401k plan with employer match.
- PTO, Self Care Day, and Floating Holiday.
- Educational Assistance Reimbursement Program.
- Employee Assistance Program.
- Health and Wellness Membership.
- Must be 18 years or older to apply for this position.
- Ability to pass a standard background check.
- Strong written and verbal communication skills
- Proficient computer skills including experience with G-Suite or Microsoft Excel
- High School Diploma or GED
- Possess valid driver’s license
- CPR/First Aid Certification and current T.B. clearance
- Physical Requirements: Ability to carry 20 pounds, type 40 words per minute
- At least 2 years experience working in the behavioral health or substance abuse field, with knowledge of general medical necessity and insurance criteria.
- To perform this job successfully, an individual must be able to perform each essential job function assigned satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The Utilization Review Case Manager will be assigned projects, based on his/her level of expertise, that include any, or all the following job responsibilities.- Timely and effective management of the individual caseload to include all assigned initial, concurrent, and discharge reviews.
- Effectively communicate any deficiencies in chart/clinical documentation to the clinical team to ensure documentation is aligned with insurance company guidelines and standards.
- Engage in strong advocacy for clients utilizing insurance, ensuring optimal length of stay .
- Exemplify time management skills by scheduling peer reviews and appeals with available licensed providers as soon as possible, to minimize risk of uncovered days and/or lack of claim reimbursement.
- Collaborate with the Director of Utilization Review and UR team on changes to LOC, authorization status, and complicated or time sensitive cases to better ensure optimal outcomes.
- Keep accurate organizational notes and records for all actions completed related to the assigned caseload throughout all applicable spreadsheets.
- Engage in any and all assigned training by the Director of Utilization Review to sharpen skill set, and increase knowledge of behavioral health utilization review.
- Effectively relay any information shared by insurance care managers for collaboration of care to the appropriate AMFM clinical team.
- Collaborate with the discharge planning team and clinical case managers by relaying any insurance information necessary to ensure a smooth and appropriate discharge plan for the individual assigned caseload.
- Demonstrate a professional attitude and support the objectives of the facility philosophy through internal and external communications and interactions with all levels of staff, patients, community and referral sources.
- 2 Days Ago
UTILIZATION REVIEW (UR) CASE MANAGER
- GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
-
Los Angeles, CA
OTHER
- Job Details Job Location: Main Hospital - Los Angeles, CA Salary Range: Undisclosed DescriptionTitle of Position: UR Case Manager Location: Gateways Hospital - Quality Assurance Exempt/Non-Exempt: Exe...
- 4 Days Ago
RN Case Manager/Utilization Review
- Amtex Systems Inc.
-
Torrance, CA
FULL_TIME
- Reporting RelationshipsThis position reports to the Director of Case Management. Accountability for the practice of nursing lies with the Senior Vice President of Patient Care Services. Utilization Re...
- 5 Days Ago
Interim Nurse Manager, Utilization Review
- Trinity Health FirstChoice
-
Fresno, CA
FULL_TIME
- Employment TypeFull timeShiftDescription:Are you an experience RN Manager, Utilization Review of Acute Care seeking your next adventure?Duration: 13-week AssignmentThe Interim Utilization Management ,...
- 1 Day Ago
Continuing Care Utilization Review Coordinator Registered Nurse
- Kaiser Permanente
-
Redwood, CA
OTHER
- Job Summary:Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.Essential Responsibilities:Conducts utilization r...
- 7 Days Ago
Continuing Care Utilization Review Coordinator RN
- Kaiser Permanente
-
Oakland, CA
OTHER
- Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.Essential Responsibilities: Conducts utilization...
- 1 Month Ago
Utilization Review Manager - Home Care jobs at Popular Companies
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- Leprino Foods
-
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- Accenture
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Director Utilization Management
- Heritage Valley Health System, Inc.
-
Beaver, PA
- Department: Utilization Review. Work Hours: Primarily Monday through Friday, extended hours as needed to support organiz...
- 6/9/2024 12:00:00 AM
Supervisor, Utilization Management
- Centene Corporation
-
Tallahassee, FL
- You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Managem...
- 6/9/2024 12:00:00 AM
Utilization Management Specialist
- Blue Cross and Blue Shield Association
-
Meridian, ID
- Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, pri...
- 6/9/2024 12:00:00 AM
Director of Utilization Management
- Oceans Healthcare
-
Jackson, MS
- Description The Director Utilization Management is responsible for oversight and management of all utilization review/ca...
- 6/8/2024 12:00:00 AM
Manager, Utilization Management
- Hiring Now!
-
New York, NY
- Creates and upholds policies and procedures for coverage determinations. Serves as subject matter expert for Medicare co...
- 6/8/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Health System
-
Beaver, PA
- Department: Utilization Review Work Hours: Primarily Monday through Friday, extended hours as needed to support organiza...
- 6/7/2024 12:00:00 AM
About California
California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second and fifth most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, S...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$84,470 to $107,686