jobs matching Utilization Review

Registered Nurse - Utilization Review - PER_DIEM - 8 Hour Days

Job Description Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company’s Workplace of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us, and discover why U.S. News & World Report has named us one of America’s Best Hospitals! What You Will Do in This Role: The Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay. The UR Case Manager secures authorization for the patient's clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review. Qualifications Requirements: Education/Certifications: Associate Degree/College Diploma fro an accredited nursing program required. Bachelors Degree in Nurse preferred. California RN License required. Experience: Minimum of 2 years experience in Case Management preferred Minimum of 3 years' Acute Care experience preferred. Why work here? Our hardworking staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for. Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address. Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring. At Cedars-Sinai, we are dedicated to the safety, health and well-being of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.

Utilization Review

Per Diem

2 weeks ago

RN-Utilization Coordinator-Geriatric Psychiatry-Per Diem

Yale New Haven Health Bridgeport, CT

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. At Bridgeport Hospital, we are committed to providing quality medical care and treatment that is coordinated and centered on the patient's specific needs. We strive to achieve benchmarks as a Patient Centered Medical Home and provide health care in a setting where patients are at the center of their care team. All employees of Bridgeport Hospital are part of the patients care team and contribute to the team approach of promoting access, continuous, comprehensive care and work to provide quality improvement in the care provided to their patients. SUMMARY In collaboration with physician(s), actively participates in the quality review process and assures continual improvement of nursing practice and quality patient care. Essential duties and responsibilities include the following . Other duties may be assigned. EEO/AA/Disability/Veteran. RESPONSIBILITIES Provides indirect care to select patients and families. Demonstrates knowledge of developmental stages and applies development theories/concepts when planning and implementing care for the adult patient as observed by supervisor and as indicated by feedback from staff. In conjunction with Care Coordinator monitors patient records to assess the effective utilization of hospital resources. Conducts admission reviews utilizing hospital approved criteria within 24 hours of admission to determine length of stay and compliance with third party payer regulations as evidenced by lack of denials. Acts as an advisor to physicians concerning documentation requirements of third party payers and contractual obligations. Reviews patients records to identify areas of under or over utilization or delays in the scheduling of hospital services. Monitors lab tests, consultations, and diagnostic tests daily to prevent duplication of services and insure completion in a timely manner as observed by supervisor and feedback from staff . Facilitates patients progress through hospital system by monitoring effective utilization of hospital services as evidenced by random review of lengths of stay. Provides appropriate information to third party payers in accordance with departmental policy and procedures as evidenced by third party coverage of hospital staff . Obtains authorization from insurance companies for Extended Care Facilities and relays information to Care Coordinator and/or Social Worker. Participates in data collection aspects of quality review. Assists staff in the collection of quality review data. JOB DESCRIPTION RESPONSIBILITIES Provides input into the design and the implementation of monitoring and evaluation strategies and tools as indicated by feedback from the Quality Management Department. Works closely with assigned Care Coordinator, Clinical Reimbursement Coordinator, and Medical Director of Care Coordination, and alerts them of all EHR issues, including observation, denials, Code 44's, etc. Utilizes relevant research findings to support and advance nursing practice and improve patient outcomes. Integrates relevant research findings into practice as evidenced by observation and feedback. Develops nursing guidelines, policies, and procedures based on pertinent research findings as evidenced by documentation. Assists health care team members in the development of research proposals as evidenced by feedback. Assists staff in the collection of research data as appropriate as evidenced by feedback from staff. Reviews pertinent research findings with health care team members as evidenced by observation and feedback from staff. Collaborates with Care Coordinator, Clinical Reimbursement Coordinator, and Medical Director of Care Coordination, in evaluating new procedures and nursing care practices with staff as evidenced by feedback. Professional Development Attends educational seminars to maintain and meet expectations set forth by hospital and departmental standards. Attends and participates in in-service meetings and other designated training events that will enhance skills on a regular basis as documented by attendance at training seminars. Maintains knowledge of trends and developments in the field of discharge planning and utilization. EDUCATION (number of years and type required to perform the position duties): BSN degree as of January 2020 EXPERIENCE (number of years and type required to meet an acceptable level of performance): 3-5 years clinical experience in the area of specialty. SPECIAL SKILLS: Strong interpersonal and leadership skills. ACCOUNTABILITY (how this position is held accountable for such as goals achievement, budget adherence, or other areas of accountability): Effective 01/01/2016, an essential function of this position is the requirement to work mandatory rotating Holidays and Weekends in addition to working regularly scheduled hours . COMPLEXITY (describe planning, problem solving, decision making, creative activity, or other special factors inherent in the responsibilities of this position): In personal and job-related decisions and actions, consistently demonstrates the values of integrity (doing the right thing), patient-centered (putting patients and families first), respect (valuing all people and embracing all differences), accountability (being responsible and taking action), and compassion (being empathetic). LICENSURE/CERTIFICATION: Current RN licensure in the State of Connecticut. EEO/AA/Disability/Veteran Additional Information 16 hours per week RN with psychiatric experience required. experience with reimbursement and insurance authorizations preferred YNHHS Requisition ID 162254

On Call Acute RN Utilization Review - Mental Health 194

Telecare Corporation Santa Cruz, CA

$70 - $86.49 / hour

“They made it easier for me to live, breathe, eat, and stay clean. Without them, I’d be waiting somewhere, waiting for someone to give me a chance to live...” - Client from Telecare What You Will Do to Change Lives The Utilization Review (UR) Nurse works collaboratively with the county or customer utilization and the treatment team to ensure that the care provided is appropriate and medically necessary. The UR Nurse also ensures that medical record documentation explains the care provided as well as the members served response to treatment. The UR Nurse will support programs as assigned and attend treatment team meetings. Shifts Available: On-Call Looking for people who can pick up shifts : Monday – Friday 7:00 AM - 3:30 PM Expected starting wage range is $70.00 - $86.49. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements. What You Bring to the Table (Must Have) Graduation from an accredited Registered Nursing Program (RN). Two (2) years of inpatient psychiatric nursing experience. Current RN State license. Current BLS certification. Must be at least 18 years of age Must be CPR, First Aid, and CPI certified (hands-on course) on date of employment or prior to providing direct client care and maintain current certification throughout employment All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification. If the position requires driving, valid driver’s license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment. Additional regulatory, contractual or local requirements may apply What’s In It For You* Paid Time Off: Eligible employees (20+ hours/week) earn PTO each pay period for vacation and personal needs, with pro-rated accrual for part-time schedules and annual carryover up to set caps. Nine Paid Holidays & Shift differentials for hourly staff (6% for PM Shift, 10% for Overnight Shift). Weekend Shift differentials for hourly staff (5% for Weekend AM Shift, 11% for Weekend PM Shift, 15% for Weekend Overnight Shift) Free CEUs, free Supervision for BBS Associate License, coaching, and mentorship Online University Tuition Discount and Company Scholarships Medical, Vision, Dental Insurance, 401K, Employee Stock Ownership Plan For more information visit: https://www.telecarecorp.com/benefits Join Our Compassionate Team Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems. The Santa Cruz County Psychiatric Health Facility (PHF) is a 16-bed locked acute psychiatric inpatient program for adults aged 18+, diagnosed with serious mental illness (SMI), experiencing a mental health emergency and require intensive treatment and support. EOE AA M/F/V/Disability *May vary by location and position type Full Job Description will be provided if selected for an interview. If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.

Utilization Review

Per Diem

1 month ago

RN Utilization Manager - (Per Diem) Care Management

UNC Health Smithfield, NC

$35.87 - $51.57 / hour

Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This may include delivering notifications to patients directly. Interface is completed verbally, via email, data base tasks, or other electronic communication and via telephone. Responsibilities: 1. Clinical Review Process - Uses approved criteria and conducts admission review/status change review within 24 hours of patient admission to the hospital to ensure appropriateness of the setting and timely implementation of the plan of care. Identifies and obtains observation status as appropriate. Partners with physicians, nursing, and other care providers to help ensure timely and accurate documentation of patient data and treatments. Communicates daily with the Case Manager to manage level of care transitions & appropriate utilization of services. Coordinates with the support center to assure third party payor pre-certification and/or re-certifications when required. Utilizes high risk screening criteria to make appropriate referrals to Manager. 2. Discharge Facilitation - Identifies patient/families with the complex psychosocial, on-going medical discharge planning issues, continuing care needs by initiating appropriate case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management assessments and interventions, using collaboration with interdisciplinary team approach, on assigned patients as appropriate to ensure optimal patient outcomes. Using approved criteria, conducts continued stay and quality reviews to monitor the patient's progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective. Enters all pertinent review data into the correct computer system in a timely manner. Consults with Physician Advisor as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management - Monitors and guides to trend interdisciplinary documentation and guides medical staff in documentation that will assist in coding accuracy, enhance quality of care, reflect accurate severity of illness and appropriate reimbursement. Facilitates patient movement to appropriate (acuity) level of care including observation status issues through collaboration with patient/family, multidisciplinary team, third party payors and resource center. Provides information regarding denials and approvals to designated entities. Assists in coordination of practice parameter development with the assigned departments/sections/specialties of Medical Staff. Oversees collection and analysis of patient care and financial data relevant to the target case types. Directs delivery of notifications to patients (includes traveling to hospital(s) to deliver notifications. Other Information Other information: Education Requirements: ● Graduation from a state-accredited school of professional nursing ● If hired after October 1, 2015, must be enrolled in an accredited program within four years of employment, and obtain a Bachelor's degree with a major in Nursing or a Master's degree with a major in Nursing within seven years of employment date. Licensure/Certification Requirements: ● Licensed to practice as a Registered Nurse in the state of North Carolina. Professional Experience Requirements: ● Two (2) years of clinical experience in a medical facility and/or comparable Utilization Management experience. Knowledge/Skills/and Abilities Requirements: Job Details Legal Employer: NCHEALTH Entity: Johnston Health Organization Unit: Care Management - Work Type: Per Diem Standard Hours Per Week: 4.00 Salary Range: $35.87 - $51.57 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Onsite Work Schedule: Weekend Location of Job: US:NC:Smithfield Exempt From Overtime: Exempt: Yes This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position. Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

Utilization Review

Per Diem

2 months ago

UTILIZATION MANAGMENT (UM) COORDINATOR - PRN

UHS Franklin, TN

Responsibilities At Rolling Hills , our mission is to offer compassionate, safe, effective behavioral healthcare treatment. We use solution-focused strategies and diligently strive for a safe and positive environment for patients, families, and employees. We never forget that we provide care and comfort to people in need. The Utilization Management Coordinator monitor appropriate utilization of services throughout the course of treatment for patients admitted to the inpatient and outpatient programs and coordinates authorizations with third-party payers. The UM Coordinator reviews cases for appropriateness of admission, continued stay, and discharge planning while assisting in the promotion and maintenance of high quality patient care. Qualifications Education/Training : Must possess a current RN license or Master's Degree in Behavioral Health field (e.g. Counseling, Social Work, Psychology) Licensure/Certification: Current TN Driver License Current CPR (training provided) Current Handle With Care (training provided) Experience: Experience in a psychiatric setting as a counselor or nurse preferred; reading, writing, and mathematical skills at the masters' degree level; skills in application of DSM methodology; excellent telephone etiquette and tact; audible speech, with good enunciation; ability to interact effectively with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes; effective oral and written communication skills; skills in analyzing and evaluating information; ability to concentrate on tasks and meet deadlines; basic data entry skills preferred; organizational, time management, problem solving, meet deadlines; basic data entry skills preferred; crisis management skills necessary; flexibility, creativity, and the ability to manage stress are necessary. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers such as, openly support and fully commit to recruitment, selections, placement, promotion and compensation of individuals withouth regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion amoung our teammates is critical to our success. Notice At UHS and all our subsidiares, our Human Resources deparments and recruiters are here to help prospective cadidates by matching skillset and expereince with the best possiblke career path at UHS and our subsidiares. We take pride in creating a highly efficient and best-in-class candidate experience. During the recrtuitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at https://uhs.alertline.com or 1-800-852-3449. UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owened subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its managment company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiares of Universal Health Services, Inc. To the extent any reference to UHS or UHS facilities on this webiste including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms "we", "us", "our" or "the company" in such context similarly refer to the operations of Universal Health Services' subsididares including UHS of Delware. Any employment referenced in this website is not with Universal Health Servicesk, Inc. but solely with one of its subsidiares including but not limited to UHS of Delware, Inc. UHS is not accepting unsolicted assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via email, the Internet or in any form and/or method without a valid written search agreement in place for this posiiton will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.