Utilization Review Manager - Home Care jobs in Fairbanks, AK

Overview

The position is primarily accountable for performing initial clinical appropriateness reviews of requests for services that require prior authorization, initial, concurrent and/or retrospective review The review process is performed in accordance with established patient (health plan) protocols/guidelines, benefits, and clinical appropriateness criteria (clinical screening criteria). This position works closely with the Care Coordinators, Discharge Planners, Social Workers, Registration and Providers to evaluate, monitor, and assure the appropriateness and medical necessity of selected care for patients as it relates to quality, continuity, and cost-effectiveness. This position works with clinical and non-clinical staff as part of the referral and/or authorization process. This position is responsible for managing utilization and, if necessary, discussing the utilization of service and standards of patient management.

About Fairbanks Memorial Hospital

Fairbanks Memorial Hospital is a non-profit facility owned by the Greater Fairbanks Community Hospital Foundation. A Joint Commission-accredited facility with 152 licensed beds, Fairbanks Memorial Hospital is the primary referral center for residents of Alaska's interior. We have a strong patient to nurse ratio, a culture of Shared Leadership, and are proud members of the Mayo Clinic Care Network. In addition to our exceptional clinical environment, our location offers incomparable lifestyle rewards away from work. In Fairbanks, small-town living, spectacular natural beauty and endless recreation combine to create a one-of-a-kind place to live, work and play.

Shift Available:

40hr/ work week.

This is not a remote position.

*Retention Incentive, Relocation & transitional housing assistance are available for experienced RNs!*

Responsibilities