Utilization Review Manager - Home Care jobs in Ohio
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 | Case Management
- Memorial Health Ohio
-
Marysville, OH
FULL_TIME
-
Job Details
Description
Clinical/Technical: Recognizes, interprets, documents, and communicates information necessary for quality patient care and related patient information. Always maintains confidentiality to protect patient’s privacy and maintains Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations. Carries out the hospital utilization review plan. Participates in daily interdisciplinary rounds. Asks clarifying questions regarding documentation, hospital course, and expected date of discharge. Provides clinical information to the payer as requested to obtain admission authorization and to support level of care. Communicates payer resources available for discharge planning to Case Management Team. Understands in-network coverage and out of network insurance coverage and impact on patients served. Communicates information to patient upon request. Coordinates with Patient Financial Services on all patients, including those without insurance coverage to obtain Hospital Care Assurance Program (HCAP) and Medicaid eligibility.
Interpersonal:Communicates in order to educate patients/ family; provides kindness and consideration in meeting the emotional needs of patients; confers with Providers and Case Management Team, interacts with ancillary staff. Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity. Communicates and assists providers as indicated. Must have excellent written, verbal and telephone communication skills. All interactions are conducted in a professional manner. Demonstrates a positive attitude. Resolves conflict through one-on-one negotiation or with the assistance of Director or designee. Demonstrates the philosophy of team concept. Participates in unit projects, attends committees as assigned, and attends monthly staff meetings. Communicates dissatisfaction with issues to Director; actively contributes to the solution of problems and refrains from promoting dissatisfaction among co-workers.
Critical Thinking: Actively looks for and creates opportunities to improve the department, staff, and personal development. Develops and demonstrates knowledge of current developments in field to maintain professional competency. Compliant with CMS, DNV, Federal, State, hospital and departmental policies and procedures. Follows the Ohio Nurse Practice Act. Understand the importance of Utilization Review and how job functions, impacts the revenue cycle, compliance, patient finances, and patient satisfaction.
Documentation: Maintains accurate data collection and timely documentation. Documentation retention practices are followed per hospital and department policy. Refrains from using unaccepted abbreviation in written documentation. When necessary, follows department downtime procedures. Maintains accurate employee records (i.e. attendance, record, education record, certifications, licensures etc.) Enters and retrieves information from computer; demonstrated competence in the electronic medical record, Microsoft/Outlook/Word/Excel, other software tools and portals as assigned.
Unit Financial Accountability: Understands and is accountable to hospital goals and benchmarks for financial viability. Is accountable for productivity and time management. Maintains appropriateness of supplies
Requirements
Completion of an accredited school of nursing with current active registration in the State of Ohio as an RN in good standing. Must have at least two years of clinical nursing or case management experience at an acute care hospital. Registered Nursing degree licensed in the State of Ohio; completes the required 24 contact hours of approved CE during each two year renewal period consistent with the Ohio Board of Nursing requirements. Maintains continuous certification in American Heart Association’s BLS.
Shift
2nd w/ every third weekend
(10:30 a.m. - 9:00 p.m.)
Hours
80 per pay (Every two weeks)
Benefits- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Flexible Spending Account
- Vacation
- Sick Leave
- 11 Paid Holidays
- Personal Day
- Ohio Public Employee Retirement System
- Deferred Compensation
- Tuition Reimbursement
- Kidzlink Daycare Center
- Employee Recognition
- Free Parking
- Wellness Center
- Competitive Salaries
- Community/Family Atmosphere
- 5 Days Ago
Utilization Review Case Manager | Case Management
- Memorial Hospital of Union County
-
Marysville, OH
FULL_TIME
- Memorial Health is an elite health and wellness system that deeply values both our patients and employees. We are looking for an experienced, team player, and strong communicator to join our team as a...
- 9 Days Ago
Utilization Review Case Manager | Case Management
- Memorial Health
-
Marysville, OH
FULL_TIME
- Clinical/Technical: Recognizes, interprets, documents, and communicates information necessary for quality patient care and related patient information. Always maintains confidentiality to protect pati...
- 17 Days Ago
Utilization Review Nurse - Utilization Management
- METROHEALTH MEDICAL CENTER
-
Cleveland, OH
FULL_TIME
- Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 64.00 Shift: variable start time, day shift The MetroHealth System is redefining health care by going beyond medical treatment to improve the found...
- 6 Days Ago
Utilization Review Clinician- PRN
- UHS
-
WILLOUGHBY, OH
PER_DIEM
- Responsibilities Windsor Laurelwood Center for Behavioral MedicineUtilization Review Clinician We are looking for a Utilization Review Clinician to join our team! In this role as UR Clinician you will...
- 2 Days Ago
Utilization Review Clinician- PRN
- Windsor Laurelwood Center For Behavioral Medicine
-
Willoughby, OH
FULL_TIME
- ResponsibilitiesWindsor Laurelwood Center for Behavioral MedicineUtilization Review ClinicianWe are looking for a Utilization Review Clinician to join our team!In this role as UR Clinician you will pe...
- 4 Days Ago
Utilization Review Manager - Home Care jobs at Popular Companies
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- Land O'Lakes, Inc.
-
Spencer, WI
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- 6/11/2024 12:00:00 AM
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-
Austin, TX
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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 Ohio
Ohio /oʊˈhaɪoʊ/ (listen) is a Midwestern state in the Great Lakes region of the United States. Of the fifty states, it is the 34th largest by area, the seventh most populous, and the tenth most densely populated. The state's capital and largest city is Columbus.
The state takes its name from the Ohio River, whose name in turn originated from the Seneca word ohiːyo', meaning "good river", "great river" or "large creek". Partitioned from the Northwest Territory, Ohio was the 17th state admitted to the Union on March 1, 1803, and the first under the Northwest Ordinance. Ohio is historically know...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$74,897 to $95,482