Utilization Management Case Mgr I

Found in: Resume Library US A2 - 1 week ago


Nokomis Florida, United States Sarasota Memorial Health Care System Full time
Job Summary:
The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care. The UMCM maintains a strong knowledge base of evidence based clinical criteria (Milliman), and federal, state UR requirements, and adeptly identifies pertinent clinical information that will support admission and continued stay hospitalization. When potential denials for payment or level of care arise, the UMCM collaborates with the floor ICM staff, Revenue Cycle, involved physicians and/or the Physician Advisors (PA) as needed to attain second level review/approval to effectively overturn the denial or help determine appropriate transition for the patient. UMCM interact extensively with clinical staff throughout the hospital, other ICM staff, physicians, payers, and hospital financial staff in order to achieve appropriate level of care or placement authorizations, and to avoid denials. The UMCM collaborates with other ICM staff to evaluate opportunities to optimize utilization and secure payer approvals across populations of patients to meet organizational strategic objectives. The UMCM acts as a mentor/preceptor for new staff.

Required Qualifications:
- Require one (1) year of case management or utilization review experience in a hospital setting; utilization experience preferred or qualified graduate of the SMHCS internal ICM Residency program.

- Require a minimum of three (3) years of related clinical practice in an acute care setting.
- Require Diploma/Associates degree in Nursing with graduation from an accredited school of nursing.
- Require basic experience using PC/computer (word processing minimum).

- Require previous experience with hospital information systems (order entry, results reporting, case management).

Preferred Qualifications:
- Prefer strong ability to communicate effectively both verbally and in written work.
- Prefer strong interpersonal skills and ability to work collaboratively with leaders, staff, patients, families, healthcare team, payers and external agencies.
- Prefer knowledge of relevant federal and state utilization review and appeal requirements.
- Prefer solid clinical assessment, critical thinking, decision making and organizational skills.
- Prefer active Case Management Certification (CCM or ACM-RN) or within one (1) year of hire and membership in relevant CM/UM organization.
- Prefer demonstrated ability to manage multiple tasks and adjust priorities according to patient and department/hospital needs.

Mandatory Education:

Preferred Education:
BSN: Bachelor of Science Nursing

Required License and Certs:
FL RN: FL Registered Nurse License

Preferred License and Certs:


  • Utilization Mgmt Case Mgr PRN

    Found in: Resume Library US A2 - 4 days ago


    Sarasota, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care. The UMCM maintains a strong knowledge base of evidence based clinical criteria (Milliman), and federal, state UR requirements, and adeptly identifies pertinent clinical...

  • Apps Support Sr Mgr

    Found in: Jooble US O C2 - 3 days ago


    Florida, United States Citibank N.A. Full time

    Apps Support Sr Mgr for Citibank, in Tampa, FL, to provide technl oversight across multiple sys's used by ISG bus. (Info Srvcs Group). Remote work permitted w/i commutable distance from worksite in accordance w/ Citi policy. Req'mts: Bach, or foreign equiv, in Info Sys, CS, Comp Eng'g, or rel field,...

  • Case Manager

    2 weeks ago


    Nokomis, United States PAM Health Full time

    Job DescriptionJob DescriptionCase Manager (RN, OT, PT, SLP or LSW)Work with us at PAM Health Rehabilitation Hospital of Venice!The Case Manager is responsible for the interdisciplinary coordination of care for a designated patient population. The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital...

  • Clinical Case Manager I

    Found in: Resume Library US A2 - 25 minutes ago


    Sarasota, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: The Clinical Case Manager (CCM) is a dynamic role that utilizes professional nursing skills to assess patient and family situations while considering clinical appropriateness for the acute or an alternate setting and establishing plans for effective management of the continuum of care (episodic and population-based) by performing assessments,...

  • Clinical Case Manager III

    Found in: Resume Library US A2 - 4 days ago


    Sarasota, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: The Clinical Case Manager (CCM) is a dynamic role that utilizes professional nursing skills to assess patient and family situations while considering clinical appropriateness for the acute or an alternate setting and establishing plans for effective management of the continuum of care (episodic and population-based) by performing assessments,...

  • Clinical Case Manager PRN

    Found in: Resume Library US A2 - 4 days ago


    Sarasota, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: The Clinical Case Manager (CCM) is a dynamic role that utilizes professional nursing skills to assess patient and family situations while considering clinical appropriateness for the acute or an alternate setting and establishing plans for effective management of the continuum of care (episodic and population-based) by performing assessments,...

  • Telephonic Nurse Case Manager

    Found in: Resume Library US A2 - 1 week ago


    Boca Raton, Florida, United States AmTrust Financial Services, Inc. Full time

    Overview: AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our...


  • Central Florida, United States Benefits Advocate Full time

    Job DescriptionJob DescriptionOverviewAt Advocate, our mission is to empower Americans to obtain the government support they've earned. Advocate aims to reduce long wait times and bureaucratic obstacles of the current government benefits application process by developing a unified intake system for the Social Security Administration, utilizing...

  • Certified Cancer Registrar

    Found in: Resume Library US A2 - 3 days ago


    Nokomis, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: Responsible for computer abstracting of cancer cases to meeting American College of Surgeons Commission on Cancer (ACOS) and Florida Cancer Data Systems (FCDS) requirements. Maintains a computerized master file and accession register. Perform a variety of duties involved in the organization, oversight, and documentation of a cancer registry in...


  • Nokomis, United States KTE Services Full time

    Job DescriptionJob DescriptionA pain management group is a rapidly expanding organization seeking a highly skilled and knowledgeable Pain Physician to join a practice in the Venice, Florida area. As a Pain Physician, you will play a crucial role in providing comprehensive pain management services to our patients. This position offers excellent earning...


  • Nokomis, United States KTE Services Full time

    Job DescriptionJob DescriptionA pain management group is a rapidly expanding organization seeking a highly skilled and knowledgeable Pain Physician to join a practice in the Venice, Florida area. As a Pain Physician, you will play a crucial role in providing comprehensive pain management services to our patients. This position offers excellent earning...

  • Case Manager Assistant

    Found in: Resume Library US A2 - 1 week ago


    Sarasota, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: Responsible for providing support to Case Managers to ensure case management services, communications, and appropriate documentation is consistently processed, while serving as a liaison for patients, family of patients, and hospital staff to ensure patient satisfaction, experience, and quality of services are delivered. Required...

  • Int Case Management Supervisor

    Found in: Resume Library US A2 - 25 minutes ago


    Sarasota, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: Welcome to Sarasota Memorial Health Care Systems Rehab Department!   Sarasota Memorial’s 60-bed inpatient rehabilitation facility is a hospital based intensive rehab dedicated to patients recovering from multi-trauma, stroke, neurological diseases such as Parkinson’s, Muscular Dystrophy, Multiple Sclerosis, and brain injury; spinal cord...

  • Immigration Case Manager

    Found in: Resume Library US A2 - 7 days ago


    Fort Lauderdale, Florida, United States Lewis Brisbois Full time

    Overview: The Fort Lauderdale office is seeking an Immigration Case Manager to join our Immigration team. Qualified candidates will have at least two years of experience as a legal assistant or paralegal with a focus on immigration law (preferably the business side) and be highly organized and capable of managing numerous cases efficiently. Must also have...

  • Immigration Case Manager

    Found in: Resume Library US A2 - 7 days ago


    Fort Lauderdale, Florida, United States Lewis Brisbois Full time

    Overview: The Fort Lauderdale office is seeking an Immigration Case Manager to join our Immigration team. Qualified candidates will have at least two years of experience as a legal assistant or paralegal with a focus on immigration law (preferably the business side) and be highly organized and capable of managing numerous cases efficiently. Must also have...


  • Nokomis, United States RANR Management Full time

    Job DescriptionJob DescriptionAt RANR Management, we connect local districts with the leading telecommunications technology available in our region. As an established yet continuously expanding firm, our strength lies in our ability to listen to the market and develop solutions for their changing needs. Communications & Marketing Associates lead our team in...

  • Case Manager II

    Found in: Resume Library US A2 - 18 hours ago


    Pensacola, Florida, United States Childrens Home Society of Florida Full time

    Overview:     Since opening our doors in 1902, CHS became a part of Florida's history.    CHS has been committed to growing and evolving to provide the right services and solutions to address the needs of children and families throughout the changing times.  Every day, our team works with parents and kids to empower them and encourage them. With...

  • Public Safety Officer I

    Found in: Resume Library US A2 - 1 week ago


    Nokomis, Florida, United States Sarasota Memorial Health Care System Full time

    Job Summary: Protects staff, patients, and visitors from harm. Implements and monitors the security management plan. Addresses security issues concerning patients, visitors, personnel, and property. Investigates and reports on security incidents. Responds to emergency situations. Controls access to and egress from sensitive areas. Provides vehicle and...

  • Immigration Case Manager

    Found in: Resume Library US A2 - 1 week ago


    Fort Lauderdale, Florida, United States Lewis Brisbois Full time

    Overview: The Fort Lauderdale office is seeking an Immigration Case Manager to join our Immigration team. Qualified candidates will have at least three (3) years of experience handling Immigration matters. The Immigration Case Manager assists the Immigration Attorneys in preparation of immigration filings and supporting documentation as assigned. Qualified...

  • Housing Case Manager

    Found in: Resume Library US A2 - 1 week ago


    Fort Lauderdale, Florida, United States AIDS Healthcare Foundation Full time

    WHO WE ARE:   SunServe is Broward County’s leading lesbian, gay, bisexual, transgender, intersex, asexual/ally and gender variant+ (LGBTQIA+) social service agency.   Our mission is to provide critical life assistance and professional mental health services with an emphasis on economically disadvantaged, marginalized youth, and senior adults in the...