Care Manager Utilization Review

3 weeks ago

St George, United States Intermountain Healthcare Full time
Job Description:
The Nurse Case Manager utilizes clinical expertise and critical thinking skills to develop and implement a plan of care that provides cost effective, extraordinary care. This position works collaboratively with patients, patient families/significant others, healthcare providers, insurers, community resources, and other involved parties.

Posting Specifics
  • Pay Range: $43.98 - $63.79 Non-Exempt
  • Benefits Eligible: Yes/No? Yes
  • FTE: Part-time
  • Shift: 24hrs/week. 8hr shifts. Days. Includes some weekends and holidays
  • Benefits Eligible: Yes; Medical, Dental, Vision, Education Assistance. Click here for more details
Job Essentials
  • Organizes and prioritizes daily work by assessing new, current, and discharging patient needs in area(s) of responsibility. Completes documentation as required.
  • Performs utilization review activities to provide patient appropriate, timely, and cost effective care. Coordinates care with patient, care providers, hospital financial services, and third-party payers.
  • Maintains an active role in denial prevention. Proactively intervenes with payers to prevent inpatient denials. Performs retroactive reviews on discharged patients as assigned. Communicates any necessary information to payers to help appeal existing denials. Uses level of care criteria to justify the patient's severity of illness and intensity of service. Reviews payer requirements and government regulations to ensure safe and cost-effective healthcare.
  • Screens and coordinates the discharge planning process from patient admission to departure. Assesses patient needs, develops a discharge plan, and coordinates with internal and external services for care during and after the hospital stay
  • Identifies patients with potential avoidable delays, extended stay, readmission, or discharge needs. Coordinates with care providers and leaders to reach optimal solutions.
  • Educates, communicates, and coordinates with multiple patient care teams to ensure the patient receives quality care, a timely discharge, and to identify and resolve delays and issues.
Minimum Qualifications
  • Current RN license for state in which the nurse practices.
  • Three years of clinical nursing experience.
  • RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.
Preferred Qualifications
  • Bachelor's degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified.
  • Case management Certification.
  • Experience in Case management, Utilization review, and/or discharge planning.


Physical Requirements:

Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess patient needs.
Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, etc.

Anticipated job posting close date:
09/08/2024

Location:
St George Regional Hospital

Work City:
St George

Work State:
Utah

Scheduled Weekly Hours:
24

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$43.98 - $63.79

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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