RN | Utilization Management | Evenings
3 days ago
Overview Monday-Friday 3p to 11:30p Emergency Department The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination tohelp patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager isresponsible for ensuring that care is provided at the appropriate level of care based on medical necessity. In addition, the Utilization Manager will work towards denial prevention, promote appropriate length of stay, and ensure compliance withstate and federal regulatory requirements. The Utilization Manager will work with payers to support admission, level ofcare, length of stay, and authorizations for services provided. Responsibilities Clinical review on all assigned patients performed to document if MCG criteria met in the appropriate setting (Inpatient or Observation). Review includes completion of Important Message from Medicare and Medicare Outpatient Observation Notices as required by Medicare and Medicare Advantage Plans. Application of MCG SI/IS criteria to assure necessity of admission/CSR (including all adults and pediatrics). Effectively summarizes and refers cases not meeting criteria to Physician Advisor. Applies regulatory requirements and policy concerning observation regarding time limitations in observation, physician order for observation, physician conversion order to inpatient, and determining the appropriate diagnostic test setting for outpatient versus inpatient. Collaborates daily with the direct care givers (care coordination, nurses, and physicians, ancillary departments) to coordinate the patient's length of stay, timely utilization, and appropriateness of those resources. Collaborates with care coordination in event of necessary referral cases. Provides documentation review to certify the admission and/or continued length of stay to the third party payers; negotiating for additional days if necessary. All documentation noted in ACM. Tracking of Avoidable Days in ACM by completing the necessary user defined fields of data. Uses this data to address opportunities for improvement. Flags cases for the Risk Manager and Quality Assurance Coordinator regarding adverse events, appropriateness of procedures, and quality of care issues. Enters Medicaid chart data into the eQHS computerized system to obtain appropriate authorization and approval of continued stay days. Also assures timely inputs of Medicaid retro reviews when eligibility is confirmed. Identifies opportunities for improvement in the hospital system processes as well as suspected problems of under or over utilization in inappropriate scheduling of services and bring attention to the Utilization Management Manager. Observes rules of confidentiality specific to the Utilization Management Department (information obtained in files, committee discussions, data security, proper disposal of QA information, etc). All other duties as assigned by department. Qualifications Education required: Associates in nursing Experience required: 3 year acute care nursing Experience preferred: Acute care utilization management Accredited Case Manager (ACM)
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St Augustine, United States UF Health Full timeOverviewMonday-Friday 3p to 11:30p Emergency Department NOT REMOTE The RN Utilization Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources. The Utilization Manager is responsible for ensuring that care is provided at...
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Utilization Management Coordinator
1 month ago
St. Augustine, Florida, United States UF Health Full timeAbout the RoleWe are seeking a Utilization Management Coordinator to join our team on a PRN basis. The successful candidate will work closely with our Registered Nurse Case Manager to provide administrative support.Key ResponsibilitiesRegulatory Letter Issuance: Assist in issuing regulatory letters, including Discharge Important Message from Medicare, MOON,...
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Evening Nurse Supervisor RN
3 days ago
Saint Cloud, United States Eden Senior Care Full time $75,000 - $86,000Eden Senior Care, founded in 2016, is a growing Healthcare Management company, focused on managing and operating Skilled Nursing, Rehabilitation and Assisted Living communities in Minnesota Wisconsin. Our mission with each community is to support their success by providing strong leadership, corporate support, and the resources and tools to realize their...
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Case Management RN Utilization Review
6 days ago
Saint Helena, California, United States Medical Solutions Full timeAre you a dedicated and compassionate nurse looking for a new challenge? Look no further than Medical Solutions' travel nurse RN position in case management. This exciting opportunity will allow you to utilize your skills in a dynamic setting.About the AssignmentDuration: 13 weeksShift: 8 hours, daysEmployment Type: TravelIn this role, you'll work closely...
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Saint Augustine, United States Res-Care, Inc Full timeRN / Registered Nurse Case Manager - HospiceOur Company Haven Hospice Overview Our Hospice Registered Nurse (RN) Case Managers are the heart of our organization! In this role, you will support your patients by providing direct care and coordinating with the interdisciplinary team to ensure that both patients and their families have an optimal care...
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Utility Infrastructure Manager
6 days ago
Saint Paul, Minnesota, United States HiFyve Full timeJob SummaryHfyve is hiring a Utility Infrastructure Manager in the Maintenance industry in St. Paul, Minnesota.The ideal candidate will have 4-6 years of experience in utility operations and management, with a strong understanding of OSHA and EPA standards.Estimated Salary: $85,000 - $105,000 per year.Key ResponsibilitiesMaintain regulatory records and...
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Utility Project Manager
6 days ago
Saint-Brieuc, Bretagne, United States Whitman, Requardt & Associates, LLP Full timeJob DescriptionWe are seeking a highly experienced Utility Project Manager to join our team at Whitman, Requardt & Associates, LLP. As a Utility Project Manager, you will be responsible for managing and performing daily construction management and inspection services for various types of utility projects in the Hampton Roads area.About UsWhitman, Requardt &...
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Utilization Management Assistant- PRN- Varied Shifts
3 months ago
St Augustine, United States UF Health Full timeOverview The Case Manager Assistant under the direct supervision of the Registered Nurse Case Manager will perform clerical duties to include but not be limited to: issuance of regulatory letters, monitoring of Sfax for authorizations and denials, transference of Medicare primary insurance information to ACM, obtaining insurance authorizations...
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Utility Operations Manager
7 days ago
Saint Peters, Missouri, United States City of St. Peters Full timeJob Summary: Utility Operations ManagerWe are seeking an experienced Utility Operations Manager to lead our utility operations team at the City of St. Peters. As a key member of our leadership team, you will be responsible for overseeing the operation and maintenance of our water treatment facilities, ensuring the safety and quality of our community's...
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Utility Operations Specialist
2 weeks ago
St. Augustine, Florida, United States Colas Full timeThe Colas Group, a world leader in transportation infrastructure construction and maintenance, is hiring a Utility Operations Specialist for its Reeves Construction Company subsidiary in St. Augustine, FL. This role involves supervising various phases of utility operation, including installation of storm drainage, water and sewer utilities.Responsibilities: ...
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Evening Shift Kitchen Attendant
2 weeks ago
Saint-Bauzille-de-Putois, Occitanie, United States Mitchell Management Full timeEvening Shift Kitchen AttendantWe are seeking a reliable and hardworking Evening Shift Kitchen Attendant to join our team at Mitchell Management. As a key member of our kitchen staff, you will be responsible for maintaining a clean and organized dish area, supporting our culinary team during service, and adhering to our high standards of quality and...
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Utility Crew Member
2 weeks ago
Saint Paul, Minnesota, United States MLP Management LLC Full timeAbout the RoleWe are currently hiring a Utility/Groundskeeper for our Edison at Rice Creek community.The ideal candidate will have a minimum of one year of experience in grounds or general maintenance, preferably in multi-family settings.Responsibilities include:Upkeep of community grounds, amenities, and building interiors/exterior.Assist in timely...
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Travel Nurse RN Utilization Review Specialist
2 weeks ago
Saint Helena, California, United States Medical Solutions Full timeAbout Medical Solutions: At Medical Solutions, we're dedicated to providing exceptional staffing solutions to the healthcare industry. Our team of experts works tirelessly to connect top talent with the best healthcare organizations, ensuring that patients receive the highest quality care.Role Overview: As a Travel Nurse RN Utilization Review Specialist, you...
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Dynamic Evening Team Lead
4 weeks ago
St. Augustine, Florida, United States Wingstop Full timeWingstop is the premier destination for those seeking authentic, high-quality wings, hand-cut fries, and mouthwatering sides. As a skilled Assistant Manager - Evenings, you will oversee and collaborate with the Store Manager to achieve key objectives in sales, employee retention, guest satisfaction, food quality, cleanliness, and sanitation.We are committed...
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Administrative RN Manager Psychiatry
2 months ago
Saint Marys, United States Clinical Management Consultants Full timeAn innovative, acute care hospital in a charming Pennsylvania suburb actively seeks a dedicated Administrative RN Manager to join their Behavioral Health team. This unique and exciting position offers immense opportunities for professional advancement. This progressive health system has a consistent patient outcome rate and offers full-service care to many...
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Utility Vegetation Management Technician
6 days ago
Saint Francisville, Louisiana, United States Xylem I LLC Full timeJob Description:We are seeking a Utility Vegetation Management Technician to join our team. In this role, you will be responsible for performing tree maintenance activities, including clearing and trimming trees, removing branches, and disposing of debris.About the Position:The salary range for this position is $70,000 - $90,000 per year.You will work at...
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Evening Nurse Leadership Position
7 days ago
Saint Cloud, Minnesota, United States Eden Senior Care Full timeJob OverviewEden Senior Care is a leading healthcare management company with a strong presence in Minnesota and Wisconsin. We are seeking an experienced Evening Nurse Supervisor to join our team at Edenbrook St Cloud, a skilled nursing facility.About the RoleThis is a critical leadership position that requires a seasoned RN with a proven track record of...
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Saint Augustine, United States University of Florida Health Full timeCharge RN | Observation Unit | Days | Full TimeOverview The Charge Nurse has responsibility for managing all aspects of nursing care during their assigned shift. This includes facilitating patient admissions, transfers and discharges as well as coordinating daily administrative duties such as scheduling, staffing and nursing care assignments. In this role,...
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Saint Augustine, United States University of Florida Health Full timeRN | Transfer Center | Days | Full TimeOverview The Transfer Center RN coordinates the successful transfer or bed placement of patients entering UF Health St. Johns. Ensures patients are assigned rooms in an expedient manner by communicating effectively with the surgery department, nursing units, physician offices, and outlying facilities to ensure...
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Electric Utility Field Technician
2 weeks ago
St. Augustine, Florida, United States Peak Utility Services Group Full timeJob OverviewWe are seeking a skilled Electric Utility Field Technician to join our team at Peak Utility Services Group. This role involves reading electric meters throughout assigned areas and regions, ensuring accurate data collection and efficient service delivery.ResponsibilitiesDrive and navigate cities in your region to read meters and disconnect...
