Utilization Review Manager - Home Care jobs in Tennessee
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 Specialist
- Delta Specialty Hospital
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Memphis, TN
FULL_TIME
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Essential Functions
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
- Perform other functions and tasks as assigned.
- Associate's degree in nursing (LPN or RN) required. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
- Two or more years' experience with the population of the facility and previous experience in utilization management preferred.
- Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
- 1 Day Ago
Utilization Review Coordinator
- Hermitage Hall
-
Nashville, TN
FULL_TIME
- Responsibilities: Hermitage Hall (a UHS company) is one of Middle Tennessee's largest stand-alone psychiatric residential treatment Hospitals. Licensed by Tennessee Department of Mental Health and Sub...
- 24 Days Ago
Utilization Review Specialist
- Cumberland Heights
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Nashville, TN
FULL_TIME
- JOB TITLE: Utilization Review Specialist DEPARTMENT: Utilization Review REPORTS TO: Utilization Review Coordinator The Utilization Review Specialist supports Cumberland Heights’ mission of transformin...
- 29 Days Ago
Utilization Review Coordinator (Remote)
- Physicians Regional Healthcare System
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Franklin, TN
FULL_TIME
- Job DescriptionCommunity Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is commit...
- 2 Days Ago
Clinical/Utilization Review Nurse
- Aspirion
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Franklin, TN
FULL_TIME
- What is Aspirion?For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denia...
- 5 Days Ago
Director - Utilization Review / Mgmt
- Lakeside Behavioral Health System
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Memphis, TN
FULL_TIME
- ResponsibilitiesLakeside Behavioral Health System provides an excellent opportunity for those seeking to be part of a team-oriented and compassionate organization. Our staff tell us that our team is t...
- 5 Days Ago
Utilization Review Manager - Home Care jobs at Popular Companies
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...
- 6/2/2024 12:00:00 AM
Manager Utilization Management
- Kaiser Permanente
-
Downey, CA
- Description: Job Summary:Manages the day-to-day operations of the Utilization Management Program in the Service Area or ...
- 6/2/2024 12:00:00 AM
Director, Utilization Management
- The Health Plan of West Virginia Inc
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Wheeling, WV
- Job Description Job Description The Director of Utilization Management provides leadership, management, oversight, and a...
- 6/1/2024 12:00:00 AM
Utilities Manager
- Devro
-
Swansea, SC
- Job Description Job Description The Utilities Manager is responsible for the day-to-day utilities operations that includ...
- 6/1/2024 12:00:00 AM
Utilization Management Coordinator
- Humana
-
Montgomery, AL
- **Become a part of our caring community and help us put health first** Humana is seeking a Utilization Management (UM) C...
- 6/1/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Sewickley
-
Beaver, PA
- Department: Utilization Review Work Hours: Primarily Monday through Friday, extended hours as needed to support organiza...
- 5/30/2024 12:00:00 AM
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...
- 5/30/2024 12:00:00 AM
Utilization Management RN
- UCHealth
-
Aurora, CO
- Description Location: UCHealth UCHlth 2450 Peoria Admin Services, US:CO:Aurora Department: UCHlth Patient Line Referrals...
- 5/16/2024 12:00:00 AM
About Tennessee
Tennessee borders eight other states: Kentucky and Virginia to the north; North Carolina to the east; Georgia, Alabama, and Mississippi on the south; Arkansas and Missouri on the Mississippi River to the west. Tennessee is tied with Missouri as the state bordering the most other states. The state is trisected by the Tennessee River.
The highest point in the state is Clingmans Dome at 6,643 feet (2,025 m). Clingmans Dome, which lies on Tennessee's eastern border, is the highest point on the Appalachian Trail, and is the third highest peak in the United States east of the Mississippi River. The ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$70,915 to $90,405