Utilization Review Manager - Home Care jobs in the United States

Job Summary

Facilitates cost-effective, quality patient outcomes and transitions by determining the appropriate level of care and providing guidance, education, and support to assigned patients.

Job Responsibilities

• Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
• Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
• Provides appropriate clinical information to payers as requested within specified time frame.
• Collaborates with the Attending Physician, Physician Advisor, Director, Manager, or Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization and delays in services and/or discharge.
• Delivers regulatory letters to patients as needed.
• Works in collaboration with the interdisciplinary team to ensure quality support of care and resource information
• May assist patients/families with referrals to community agencies, post-acute providers, and/or provide education and resources.
• Provides education and acts as a resource for physicians, staff, and patients/families regarding case management processes.
• Trains new case managers, students, and interns as needed.

Qualifications

• Associate's degree or higher in Nursing required upon hire AND
• Bachelor's degree or higher in Nursing required within 5 years of employment in this position
• No experience required
• RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire

Skills and Attributes

• Requires critical thinking skills and decisive judgment.
• Works under minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Physical Demands

• Standing: Frequently
• Walking: Frequently
• Sitting: Frequently
• Lifting 0-25 lbs: Frequently
• Lifting 25-75 lbs: Rarely
• Lifting over 75 lbs: Rarely
• Carrying 0-25 lbs: Frequently
• Carrying 25-75 lbs: Rarely
• Carrying over 75 lbs: Rarely
• Pushing/Pulling 0-25 lbs: Frequently
• Pushing/Pulling 25-75 lbs: Frequently
• Pushing/Pulling over 75 lbs: Frequently
• Climbing: Occasionally
• Bending/Stooping: Frequently
• Kneeling: Occasionally
• Crouching/Crawling: Occasionally
• Reaching: Frequently
• Talking: Frequently
• Hearing: Frequently
• Repetitive Foot/Leg Movements: Rarely
• Repetitive Hand/Arm Movements: Frequently
• Keyboard Data Entry: Frequently
• Running: Occasionally
• Vision: Depth Perception: Frequently
• Vision: Distinguish Color: Frequently
• Vision: Seeing Far: Frequently
• Vision: Seeing Near: Frequently

Owensboro Health Core Commitments

INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.

RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.

TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.

INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.

SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.

EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.