Current jobs related to Nursing Specialist in Utilization Management - Mount Gilead, Ohio - Morrow County Hospital
-
Employment Specialist
3 days ago
Mount Gilead, Ohio, United States Morrow County Job & Family Services Full timeMorrow County Job & Family Services is seeking a skilled Eligibility Referral Specialist 2/Employment Specialist to provide case management employment services to eligible youth and determine eligibility for child care, supportive services, incentives, and community resources.The ideal candidate will possess excellent communication and time management...
-
Mount Gilead, Ohio, United States Utilities Service Co Inc Full timeJob Title: GroundpersonThe Groundperson is a vital member of our team, responsible for ensuring the safe and efficient operation of our equipment and vehicles. This role requires a strong attention to detail, excellent communication skills, and the ability to work effectively in a fast-paced environment.Key Responsibilities:Operate chainsaw to cut brush,...
-
Psychosocial Support Specialist
1 week ago
Mount Gilead, Ohio, United States Flying Horse Farms Full timeJob OverviewFlying Horse Farms is seeking a dedicated Psychosocial Coordinator to join our team. As a key member of our Clinical Team, you will play a vital role in ensuring the well-being and success of our campers.In this role, you will collaborate with our Medical and Cabin Life teams to provide support to campers with medical or behavioral needs. You...
-
Nursing Professional
1 month ago
Mount Gilead, Ohio, United States Ohio's Hospice Full timeJob SummaryWe are seeking a skilled Nursing Professional to join our team in an Extended Hours role. As a member of our team, you will provide high-quality care to patients and their families, utilizing the nursing process of assessment, planning, interventions, implementation, and evaluation.Key ResponsibilitiesDeliver care to patients utilizing the nursing...
-
Mount Gilead, Ohio, United States Nelson Tree Service Full timeJob Title: Foreperson (Driver License Required/CDL Preferred)This position is responsible for ensuring the productivity of daily operations, working closely with management to determine recruiting/hiring needs, deadlines, and safety protocols to enforce among crew.The Foreperson is responsible for troubleshooting routine job site issues and engaging all...
-
Emergency Nurse
2 weeks ago
Mount Gilead, Ohio, United States Morrow County Hospital Full timeJob Summary: We are seeking a skilled and compassionate Emergency Nurse to join our team at Morrow County Hospital. As a key member of our Emergency Department, you will provide high-quality patient care, work collaboratively with our interdisciplinary team, and contribute to the hospital's mission of delivering exceptional healthcare...
-
Foreperson - Line Clearance Specialist
2 weeks ago
Mount Gilead, Ohio, United States Nelson Tree Service Full timeJob Title: ForepersonThis role is responsible for ensuring the productivity of daily operations, working closely with management to determine recruiting/hiring needs, deadlines, and safety protocols to enforce among crew. The Foreperson is responsible for troubleshooting routine job site issues and engaging all employees/contractors on required training,...
-
Facilities Maintenance Specialist
2 weeks ago
Mount Gilead, Ohio, United States Flying Horse Farms Full timeJob SummaryWe are seeking a highly skilled and experienced Facilities Maintenance Technician to join our team at Flying Horse Farms. The successful candidate will be responsible for ensuring the maintenance and upkeep of our facilities, including buildings, grounds, and equipment.Key ResponsibilitiesProvide daily supervision of assigned team members and...
-
Nurse Practitioner
4 weeks ago
Mount Gilead, Ohio, United States Ohio's Hospice Full timeJob SummaryWe are seeking a compassionate and skilled RN/LPN to join our team as an Extended Hours nurse. This is a PRN on-call position that requires flexibility and a commitment to providing exceptional care to our patients and their families.Key ResponsibilitiesDeliver high-quality patient care utilizing the nursing process of assessment, planning,...
-
Perioperative Surgical/Endo Tech Specialist
1 week ago
Mount Gilead, Ohio, United States Morrow County Hospital Full timeJob SummaryThe Surgical Technologist and/or Certified Surgical Technologist prepares the room and gathers supplies needed for surgical procedures; delivers instruments and supplies to the surgeon and other members of the surgical team intraoperatively; may function as second assistant to the surgeon; assists in the proper decontamination of the room,...
-
Guest Experience Manager
2 weeks ago
Mount Gilead, Ohio, United States McDonald's Full timeGuest Experience LeaderAt McDonald's, we're committed to providing an exceptional experience for our guests. As a Guest Experience Leader, you'll play a vital role in ensuring our customers feel valued and satisfied with their visit.Key Responsibilities:Lead the guest experience by checking in with customers and ensuring they're enjoying their visit.Be the...
-
Occupational Therapist Home Health Specialist
1 month ago
Mount Gilead, Ohio, United States MLee Healthcare Staffing and Recruiting, Inc Full timeOccupational Therapist - Home Health Job SummaryWe are seeking a skilled Occupational Therapist to join our team at MLee Healthcare Staffing and Recruiting, Inc.**Job Summary:**As a Home Health Occupational Therapist, you will be responsible for developing tailored rehabilitation strategies for patients in their homes.**Key Responsibilities:*** Develop and...
-
Nurse Practitioner
4 weeks ago
Mount Gilead, Ohio, United States Matrix Medical Network Full timeAbout UsMatrix Medical Network is a leading provider of clinical services and care management solutions. Our team of experienced healthcare professionals is dedicated to delivering high-quality care to patients in their homes and communities.Job SummaryWe are seeking a skilled Nurse Practitioner to join our team on a PRN/Part Time basis. As a Nurse...
-
Occupational Health Nurse
4 days ago
Mount Gilead, Ohio, United States The Cigna Group Full timeOccupational Health Nurse OpportunityEvernorth Direct Health is a leading business providing custom care delivery and wellness services across four key business lines: Wellness Centers, Health Coaching, Wellness Events, and COVID-19 solutions.We are seeking an experienced Occupational Health Nurse to join our team in Mt Gilead and Thomasville, NC. As an...
-
Mount Gilead, Ohio, United States Utilities Service Co Inc Full timeJob Title: GroundpersonThe Groundperson is a crucial member of our team, responsible for ensuring the safe and efficient operation of our wood chippers and equipment. This role requires attention to detail, physical stamina, and a commitment to maintaining a safe working environment.Key Responsibilities:Operate chainsaws to cut brush and logs, and feed them...
-
Nurse Practitioner
4 days ago
Mount Gilead, Ohio, United States Morrow County Hospital Full timeJob Summary: We are seeking a skilled and compassionate Registered Nurse to join our Acute Care Unit team at Morrow County Hospital. As a Registered Nurse, you will be responsible for providing high-quality patient care, collaborating with the healthcare team, and promoting a positive and supportive work environment. Key Responsibilities: Perform patient...
-
Nurse Practitioner
1 week ago
Mount Gilead, Ohio, United States Matrix Medical Network Full timeAbout the Role:Nurse Practitioners play a vital role in Matrix Medical Network's mission to improve the quality of care for at-risk individuals. As a PRN/Part Time Home Risk Assessment Nurse Practitioner, you will conduct comprehensive health assessments in the comfort of patients' homes, providing unmatched insight into their overall health and...
-
Nurse Practitioner
1 week ago
Mount Gilead, Ohio, United States Morrow County Hospital Full timeJob SummaryWe are seeking a skilled and compassionate Registered Nurse to join our Acute Care Unit team at Morrow County Hospital. As a critical care nurse, you will provide high-quality patient care and work collaboratively with our interdisciplinary team to ensure the best possible outcomes for our patients.Key ResponsibilitiesProvide direct patient care,...
-
Nurse Practitioner
4 days ago
Mount Gilead, Ohio, United States Matrix Medical Network Full timeAbout Us:Matrix Medical Network offers a range of clinical services and expertise that give primary care providers and at-risk health plan members the tools and knowledge to better manage their health at home. Our national network of clinicians breaks through traditional barriers to care by meeting those members where they are.We help older adults and other...
-
Physician - Anesthesiology Specialist
3 days ago
Mount Gilead, Ohio, United States Cross Country Locums Full timeAnesthesia Coverage in OhioWe are seeking an experienced Anesthesiology Physician to provide coverage in Ohio. The ideal candidate will have a strong background in anesthesia care and be able to work independently in a critical access hospital setting.Key Responsibilities:Provide anesthesia care for patients undergoing general surgery, orthopedic, and other...
Nursing Specialist in Utilization Management
2 months ago
Summary: The role involves evaluating patient documentation to ascertain the validity of hospital admissions, treatment plans, and duration of stay, ensuring adherence to reimbursement policies set by governmental and insurance entities. This position plays a crucial part in delivering high-quality care while maintaining fiscal accountability.
Key Responsibilities:
Daily Operations:
- Conducts daily reviews of patient census to identify new admissions.
- Assesses managed care, commercial insurance, and Medicare patients in observation or admission status using established criteria.
- Engages with medical and nursing teams to verify treatment legitimacy and appropriate length of stay.
- Communicates with healthcare providers regarding patient certification days and insurance inquiries.
- Secures necessary certifications and monitors ongoing length of stay from commercial payers, ensuring accurate documentation for clinical updates and potential denials.
- Facilitates interdisciplinary discharge planning meetings for acute care.
- Collaborates with social services to guarantee timely and suitable patient discharges and referrals.
Quality Assurance:
- Assists in maintaining quality care standards through medical record evaluations and risk management follow-ups.
- Works alongside the Quality/Risk Manager to address quality issues identified during utilization review processes.
- Inputs data on Core Measures into relevant databases and collaborates with the Quality/Risk Manager on these metrics.
- Reports quality data in appropriate meetings.
Data Management:
- Maintains comprehensive monthly logs for inpatients, swing beds, and admissions.
- Extracts data from medical records, compiles statistics, and prepares necessary reports.
- Generates monthly and annual statistical reports regarding admissions and readmissions.
- Coordinates with Health Information Management and administrative staff to ensure timely data reporting.
Financial Oversight:
- Identifies and documents trends in resource management, quality of care, and financial performance.
- Collects and inputs data for billing related to observation patients.
- Collaborates with the billing department to reconcile charges.
- Tracks and manages appeals for denied inpatient services in conjunction with healthcare providers and payers.
Additional Responsibilities:
- Assists with communications to regulatory agencies.
- Provides training to medical and nursing staff on documentation compliance.
- Possesses knowledge of coding guidelines to identify primary and secondary diagnoses.
- Conducts medical record reviews to support risk management initiatives.
- Offers coverage for social work duties as necessary.
Meetings:
- In partnership with the Health Information Management manager, leads utilization management meetings.
- Participates in other essential meetings as required.
Supervisory Duties:
This position does not include supervisory responsibilities.
Qualifications: To be successful in this role, candidates must meet the following criteria:
Education and Experience: Must be a graduate of an accredited nursing program with 3-5 years of nursing experience, including administrative capabilities and demonstrated nursing proficiency. Experience in utilization review or case management is preferred.
Skills: Proficient in reading, analyzing, and interpreting business documents, professional journals, and regulatory guidelines. Capable of writing reports and business correspondence effectively.
Mathematical Skills: Ability to perform calculations involving percentages, proportions, and basic algebra.
Reasoning Skills: Ability to address practical problems and interpret various instructions.
Computer Skills: Basic proficiency in PC usage is required.
Licenses and Certifications:
Must hold a current RN license.
Physical Demands: The physical requirements for this role include regular sitting, use of hands, and occasional lifting of up to 25 pounds. Reasonable accommodations may be made for individuals with disabilities.
Work Environment: The work environment is typically quiet, with occasional exposure to mechanical parts and airborne particles.
