Clinical Utilization Manager

3 days ago

Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time
Job Title: Clinical Utilization Manager

Shaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.

About the Role:

This is a unique opportunity to work in a dynamic and fast-paced environment, collaborating with healthcare professionals to review medical necessity and ensure the best possible outcomes for our patients.

Responsibilities:
  • Perform admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines.
  • Collaborate with primary nurses and other healthcare providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
  • Manage observation level of care and work with attending physicians and/or clinical providers to ensure observation status does not exceed 48 hours.
  • Identify system issues that serve as barriers to care and participate in development and implementation of strategies to remove barriers and facilitate performance improvement measures.
  • Monitor efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
  • Report information generated from the utilization management referral process for LOS data and physician profile database.
  • Collaborate with unit medical directors and/or physician advisors to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
  • Notify physicians when patients do not meet criteria for acute care hospitalization and pursue documentation to justify continued stay within 24 hours.
  • Present "Letters of Non-Coverage" to patients and/or families when acute stay is no longer necessary.
  • Communicate and secure continued stay authorization with Managed Care Organizations.
  • Track all carve-outs and submit reason codes for data entry.
  • Serve as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
  • Trend potential barriers to patient advancement through the system, intervene assertively and appropriately when necessary.
  • Provide on-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to Christiana Care.
  • Identify need for patients to be evaluated by other members of the healthcare team and take appropriate action to facilitate.
Requirements:
  • Active DE RN licensure or compact state RN licensure.
  • Bachelor's degree in nursing.
  • Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting.
  • Clinical documentation, performance improvement, case management, or utilization management experience desirable.
  • Completes a minimum of 8 continuing education credits (CEU's) per year in utilization and/or case management.
  • Actively participates in department operational planning work groups.
What We Offer:
  • Medical, dental, vision, life insurance, tuition assistance, and more.
  • Two retirement planning offerings, including 403(b) with company contributions.
  • Generous paid time off with annual rollover and opportunities to cash out.
  • 12-week paid parental leave.
  • Incredible work/life benefits, including annual membership to, access to backup care services for dependents through, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets, and much more.
About Us:

Christiana Care is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. We offer a comprehensive benefits package, opportunities for professional growth and development, and a supportive work environment that values diversity, equity, and inclusion.

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerWe are seeking a skilled Clinical Utilization Manager to join our team at Shaker for ChristianaCare Direct. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:The Clinical Utilization Manager will be...

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerShaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:This is a challenging and rewarding opportunity for...

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerWe are seeking a skilled Clinical Utilization Manager to join our team at Shaker for ChristianaCare Direct. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:The Clinical Utilization Manager will be...

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerShaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:This is a unique opportunity to work in a dynamic...

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerShaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:This is a unique opportunity to work in a dynamic...

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerShaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:This is a unique opportunity to work in a dynamic...

  • Clinical Utilization Manager

    3 days ago

    Cincinnati, Ohio, United States Shaker for ChristianaCare Direct Full time

    Job Title: Clinical Utilization ManagerShaker for ChristianaCare Direct is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.About the Role:This is a unique opportunity to work in a dynamic...

  • Clinical Laboratory Project Manager

    3 weeks ago

    Cincinnati, Ohio, United States Medpace Full time

    Position Overview:Medpace Reference Laboratories (MRL) is in search of a dedicated Project Manager to join our team. MRL serves as a comprehensive central clinical trial laboratory, providing a range of services including project oversight, laboratory operations, data management, logistics, and sample management along with quality assurance.Key...

  • Radiology Technologist

    2 weeks ago

    Cincinnati, Ohio, United States UC Health Full time

    About the RoleWe are seeking a skilled Radiology Technologist to join our team in the Pain Management Clinic at UC Health. As a key member of our diagnostic imaging team, you will play a critical role in providing high-quality patient care and contributing to the advancement of medical knowledge.Key ResponsibilitiesCommunicate effectively with patients and...

  • Radiologic Technologist for Pain Management Clinic

    2 weeks ago

    Cincinnati, Ohio, United States UC Health Full time

    Job Overview We are seeking a dedicated Radiology Technologist for our Pain Management Clinic during the first shift. As a Radiology Technologist, you will play a crucial role in supporting the diagnostic and therapeutic processes at our Pain Management Clinic. Your primary responsibility will be to generate high-quality radiographic images of...

  • Radiology Technologist, Pain Management Clinic, First Shift

    6 days ago

    Cincinnati, Ohio, United States UC Health Full time

    About the RoleRadiologic Technologist needed for the Pain Management Clinic at University of Cincinnati Medical Center. This is a PRN position for first shift.Key ResponsibilitiesSupport the Pain Management Clinic by producing diagnostic radiographs of the human body.Use independent judgment to determine the quality of radiographs and compliance with...

  • Clinical Scheduling Manager

    2 weeks ago

    Cincinnati, Ohio, United States Carefirst Urgent Care Full time

    Company OverviewCareFirst Urgent Care is a leading walk-in clinic dedicated to providing high-quality healthcare services. We focus on treating non-life-threatening conditions and offer various services, including physical examinations and pre-employment drug screenings. Our mission is to deliver comprehensive healthcare solutions to our patients.Position...

  • Clinical Application Specialist

    3 weeks ago

    Cincinnati, Ohio, United States Outset Medical Full time

    Position Overview:The Clinical Application Specialist will deliver strategic support for sales and marketing initiatives, concentrating on clinical application and product education for the Tablo device and Outset Medical. This role encompasses assisting current clients and instructing new clients on the safe and effective operation of Tablo. The Clinical...

  • Radiology Technologist

    5 days ago

    Cincinnati, Ohio, United States UC Health Full time

    About the RoleWe are seeking a skilled Radiology Technologist to join our team in the Pain Management Clinic at UC Health. As a key member of our diagnostic imaging team, you will play a critical role in providing high-quality patient care and contributing to the advancement of medical knowledge.Key ResponsibilitiesCommunicate effectively with patients and...

  • Clinical Program Manager

    2 weeks ago

    Cincinnati, Ohio, United States Best Point Education & Behavioral Health Full time

    Job SummaryBest Point Education & Behavioral Health is seeking a highly skilled Clinical Program Manager to oversee the day-to-day operations of our Day Treatment programs. This individual will provide clinical and administrative supervision to a team of behavioral health staff, ensuring the delivery of high-quality services to our clients.Key...

  • Clinical Application Specialist

    3 weeks ago

    Cincinnati, Ohio, United States Outset Medical Full time

    Position Overview:The Clinical Application Specialist will play a crucial role in supporting sales and marketing initiatives, focusing on clinical application and product education for the Tablo device and Outset Medical. This position involves assisting current clients and training new users on the safe and effective operation of Tablo. The Clinical...

  • Clinical Application Specialist

    3 weeks ago

    Cincinnati, Ohio, United States Outset Medical Full time

    Position Overview:The Clinical Application Specialist will play a crucial role in supporting sales and marketing initiatives, focusing on clinical application and product education for the Tablo device and Outset Medical. This position involves assisting current clients and training new users on the safe and effective operation of Tablo. The Clinical...

  • Radiology Technologist, Pain Management Clinic, First Shift

    12 hours ago

    Cincinnati, Ohio, United States UC Health Full time

    About the RoleWe are seeking a skilled Radiology Technologist to join our Pain Management Clinic team on a part-time basis. As a Radiologic Technologist, you will play a critical role in supporting the diagnosis and treatment of patients by producing high-quality diagnostic radiographs.Key ResponsibilitiesCommunicate effectively with patients and staff to...

  • Dishwasher and Utility Person

    5 days ago

    Cincinnati, Ohio, United States Annette's Corral, LLC dba Golden Corral Full time

    About the Role:The Utility Person/Dishwasher is a vital member of our team at Annette's Corral, LLC dba Golden Corral. This role is responsible for maintaining the cleanliness and organization of our restaurant, ensuring a pleasant and safe environment for our guests and colleagues.Key Responsibilities:Provide clean and sparkling silverware and dishes to our...

  • Clinical Nursing Manager

    2 weeks ago

    Cincinnati, Ohio, United States Carespring Full time

    We are seeking a skilled and dedicated RN Unit Manager to lead our nursing team at Carespring.Compensation: $87,500 to $95,000 Per YearKey Responsibilities:Provide direction to nursing personnel by managing daily operations of the Nursing Department.Ensure adherence to Department of Health regulations.Foster a culture of exceptional customer service and...