Utilization Review Manager - Home Care jobs in Allentown, PA
Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
Recently Added Utilization Review Manager - Home Care jobs
Utilization Review Assistant
- St. Lukes Hospital
-
Bethlehem, PA
FULL_TIME
- St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Utilization Review Assistant is responsible for taking the data provided to their department and using it to communicate necessary information to both the Utilization Review Nurses and insurance companies. Making sure that all necessary information is communicated to the appropriate party in a timely fashion is imperative so that the patients are able to receive the proper level of care and to help ensure coverage for care by the insurance company for services rendered to patients. JOB DUTIES AND RESPONSIBILITIES: Organizes and prioritizes daily work and assigned tasks by assessing new, current, and discharged patients in area(s) of responsibility accurately and within specified time limits. Establish and maintain positive and effective communication with other departments to provide needed information on accounts to ensure daily caseload is worked successfully. Establish and maintain positive and effective communication with Insurance Nurses to ensure understanding of all individual patient cases. Manages telephones, emails, faxes and handles inquiries appropriately. Return phone calls to providers and follow up with requests in a timely fashion. Scan determinations of all inpatient and outpatient requests. Request, process and track high volume of inpatient and outpatient authorization requests for observation and inpatient admissions from insurance companies via phone, fax or insurance online portal for services. Fax or upload notifications of admissions, initial and continued stay reviews to the insurance company via EPIC or online portals. Actively monitors and completes multiple workqueues. Detailed system documentation of admission authorization in the hospital account record. Supply insurance companies with discharge dates and dispositions. Requests retrospective authorizations on discharged patients as assigned. Maintains an active role in denial prevention. Proactively intervenes with payers to prevent inpatient denials. Communicates any necessary information to payers to help existing denials. Keep leadership advised of status of current patients, in regard to utilization activities through timely documentation and participate in performance improvement activities. Provide support to Network Director Utilization Review, Utilization Review Nurses and the Supervisor to Utilization Review Assistants. Acts as a liaison with the Registration, Finance Department, Business Office, Physician groups, and all internal/external sources regarding authorizations, denials, and inquiries relative to utilization review. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for one to 5 hours per day, 1 ½ hours at a time. Standing for up to 2 hours per day, up to 30 minutes at a time. Walking for up to 30 minutes a day, up to 10 minutes at a time. Frequently uses fingers for typing and writing. Occasionally uses fingers, hands for turning/twisting. Rarely uses the hand for firm grasping. Frequently lifts, carries, pushes and pulls objects up to 10 pounds, occasionally pulls items up to 25 pounds. Frequently stoops, bends, occasionally crouches and reaches above shoulder level. Frequently kneels and squats. Must have the ability to touch as related to telephone and computer keyboard. Must have the ability to hear as it relates to normal conversations and high and low frequencies in person and on the telephone. Has ability for seeing as relates to general vision, peripheral vision and vision monotony. Able to speak clearly as related to communication on the telephone and in person. EDUCATION: H.S. Diploma. Associate degree in the business/secretarial field preferred. TRAINING AND EXPERIENCE: A minimum of two (2) year's relevant experience in the healthcare field such as, registration, insurance verification or similar positions required. Medical terminology experience required. Pre-authorization and pre-certification experience preferred. Demonstrates comprehensive knowledge of computer skills in a variety of software programs, i.e. Microsoft Word, Excel, and Power Point. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer. Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 300 outpatient sites. With annual net revenue of $3.5 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Fortune/Merative 11 times total and eight years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Luke’s was identified as one of the 15 Top Health Systems nationally. SLUHN has been named a Top Workplaces 2023 by the Morning Call. In addition, St. Luke’s has been named a Top Workplace nationally, in the Philadelphia region, and in New Jersey. St. Luke’s is the ONLY healthcare institution in Pennsylvania and the third-highest ranked healthcare entity in the nation to be deemed a Top Workplace in 2023. In 2023, St. Luke’s was named one of America’s Best Employers for Women by Forbes. St. Luke’s was the only employer in the Lehigh Valley to be named to the list and was one of only two healthcare employers in Pennsylvania to receive the designation. St. Luke’s University Health Network is the top-ranked Lehigh Valley-based employer in Forbes Magazine’s ranking of employers in Pennsylvania. Learn More Here.
- Just Posted
Utilization Review Coordinator (REMOTE)
- Pyramid Healthcare
-
Allentown, PA
FULL_TIME
- With this position you would have the ability to work from home!! Shift: Monday-Friday 8:00 am - 4:30 pm Deliverables/Principal Results Expected: • Perform admission, continued stay and discharge revi...
- 3 Days Ago
Utilization Review Nurse
- St. Lukes Hospital
-
Bethlehem, PA
PART_TIME
- St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisf...
- 1 Month Ago
Care Team Manager
- Patriot Home Care
-
Allentown, PA
OTHER
- Overview We are a leading provider of homecare services throughout the states of Pennsylvania and Delaware. Our mission is to provide exceptional and compassionate homecare services to patients who ne...
- 1 Month Ago
Care Assessment Manager
- Patriot Home Care
-
Allentown, PA
OTHER
- Overview We are a leading provider of homecare services throughout the states of Pennsylvania and Delaware. Our mission is to provide exceptional and compassionate homecare services to patients who ne...
- 27 Days Ago
Patient Care Advocate
- Oakland Manager LLC dba Justice Grown
-
Bethlehem, PA
FULL_TIME
- The Patient Care Advocate (PCA) is responsible for creating an exceptional customer experience for our medical dispensary patients. This role ensures all sales are compliant with state regulations, th...
- 1 Month Ago
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0 Utilization Review Manager - Home Care jobs found in Allentown, PA area
Municipal Project Manager
- Midatlantic Employers' Association
-
Allentown, PA
- Job Description Job Description Municipal Project Manager Our client is an established full-service engineering consulti...
- 4/24/2024 12:00:00 AM
Project Coordinator
- ThreePDS Inc. Recruiting, Staffing, and Consulting
-
Allentown, PA
- Job Description Job Description SUMMARY: Coordinates all Center for Professional Excellence and Nursing Quality departme...
- 4/23/2024 12:00:00 AM
Store Manager
- Grocery Outlet
-
Allentown, PA
- Job Description Job Description Grocery Outlet is one of the fastest growing discount grocery chains in America. Were se...
- 4/23/2024 12:00:00 AM
Regional Support Supervisor
- ABF Freight
-
Allentown, PA
- Now is your chance to join one of the country's largest and most trusted LTL carriers: ABF Freight is looking for new te...
- 4/22/2024 12:00:00 AM
Program Manager
- Community options
-
Allentown, PA
- Community Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states...
- 4/22/2024 12:00:00 AM
Project Manager-EU
- PPL Corporation
-
Allentown, PA
- Company Summary Statement : PPL Electric Utilities delivers safe, reliable and affordable electricity to more than 1.4 m...
- 4/21/2024 12:00:00 AM
Team Supervisor (Overnights)
- Wawa, Inc.
-
Emmaus, PA
- Job Description Job Title: Team Supervisor Location: Field Department: Store Operations *Associates in this position wil...
- 4/21/2024 12:00:00 AM
Project Manager Electric Utilities
- Leidos
-
Allentown, PA
- Description At Leidos, we deliver innovative solutions through the efforts of our diverse and talented people who are de...
- 3/5/2024 12:00:00 AM
About Allentown, Pennsylvania
Allentown (Pennsylvania Dutch: Allenschteddel) is a city located in Lehigh County, Pennsylvania, United States. It is Pennsylvania's third most populous city and the 231st largest city in the United States. As of the 2010 census, the city had a total population of 118,032 and is currently the fastest growing city in all of Pennsylvania. It is the largest city in the metropolitan area known as the Lehigh Valley, which had a population of 821,623 residents as of 2010[update]. Allentown constitutes a portion of the New York City Combined Statistical Area and is the county seat of Lehigh County. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$76,871 to $98,004
Allentown, Pennsylvania area prices
were up 1.5% from a year ago
were up 1.5% from a year ago