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)
Under general supervision, the Utilization Review Case Manager (UR CM) performs review of patient referral and medical record for appropriateness for Skilled Home Health services. The UR CM validates the patient’s admission and appropriate visits based on the skilled needs of the patient. The UR CM uses medical necessity based on the Skilled Clinician Start of Care assessment and ongoing needs. The UR CM secures authorization for the patient’s clinical services through collaboration and communication with payers as required. The UR CM provides oversight for the patients continued skilled needs, number of visits and secures authorization from the health plan. The UR CM is a liaison between home health and the health plan. |
Core Competencies |
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Department Specific Competencies |
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Education | |
Degree | Program |
Associates | Nursing |
Experience | |
Number of Years Experience | Type of Experience |
1 | Home Health Experience |
Experience with OASIS case management in Home Health
License / Certification Requirements |
Registered Nurse License |
Compensation Range $53.40 - $82.22 / Hour |
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0 Utilization Review Manager - Home Care jobs found in Long Beach, CA area