Utilization Review Manager - Home Care jobs in Minneapolis, MN

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)

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Utilization Review Analyst - Full Time
  • NUWAY
  • Saint Paul, MN FULL_TIME
  • Position Overview
    The Utilization Review Analyst will support the Utilization Review department which acts as a liaison between the clinical treatment team and third-party payers to promote appropriate treatment services, documentation practices and billing integrity for SUD treatment. The Utilization Review Department position ensures system integrity through the treatment continuum from clinical to claims management. Utilization Review Analysts work in a team environment and collaborate with each other to support the department’s responsibilities within NUWAY Alliance as well as other members of the team. This position will also work in conjunction with other departments within the organization to support improvement in the overall quality, completeness and accuracy of medical record documentation.
    This position allows for a hybrid workplace, utilizing a telecommute work environment. The Utilization Review Analyst must be able to maintain client confidentiality in accordance with state and federal guidelines and HIPAA requirements.
    Responsibilities
    • Audit documentation across NUWAY Alliance programs to substantiate appropriate clinical documentation practices, inclusive of providing data and feedback to staff and leadership about patterns, trends and gap analysis
    • Collaboration with Admissions and Clinical teams to identify clients entering treatment programming to determine funding
    • Secure funding for client’s admitting into NUWAY Alliance programs and documents approved funding source with approval units and/or dates
    • Complete documentation to support extension of funding for programming services, while reviewing medical necessity criteria
    • Develop and maintain efficient processes related to client funding, including prior authorizations and concurrent reviews for third party payors
    • Facilitate communication with Clinical teams to obtain appropriate clinical documentation to ensure that clinical documentation reflects the level of service rendered to clients is complete, accurate and medically necessary
    • Communicate data related to insurance payers, denials and extension requests in a clear and timely manner
    • Maintain current information about third party criteria for reimbursement and establish and maintain relations with payers to promote positive and direct communication
    • Support all Medical Records Requests from third party payers
    • Serve cross-functionally with Clinical teams, Leadership and Billing/Revenue Cycle teams, as well as other internal teams to assist in identification of overpayments
    • Support the execution of internal controls to prevent issues with billing, documentation and other processes as applicable
    • Maintain positive and open communications NUWAY Alliance staff, departments and leadership
    • Conduct oneself in a manner that presents a positive reflection of professionalism, as an asset to the image of the organization
    • Other duties as assigned or required
    Competencies
    • Support the Clinical teams with regulation and standard implementation and understanding of the utilization review process
    • Utilize clinical knowledge and licensure to support utilization review activities of the organization
    • Understand and apply the importance of self-awareness in one’s personal, professional, and cultural life
    • Provide services appropriate to the personal and cultural identity and language of the client and other professionals
    • Understand the treatment modalities and clinical application to practice at NUWAY to support effective training resources
    Qualifications, Skills, Knowledge and Experience
    Required:
    • Bachelor’s degree with a major or concentration in a related field
    • Current LADC license required
    • Age 18 or older
    • Clinical documentation integrity, clinical quality improvement, utilization review, discharge planning, or case management experience of at least one year
    • At least 1 year of providing Substance Use services in an individual and group counseling setting
    • Knowledge of ICD-10 and DSM-5
    • Able to pass Minnesota DHS background study
    • Must be free of problematic substance use for at least two years immediately preceding employment and must sign a statement attesting to that fact
    • High degree of computer literacy including experience using an electronic health records (EHR) system
    • Excellent written, communication, customer service, and case management skills
    • Ability to relate to people from diverse backgrounds
    • Demonstrated working knowledge in the field of substance use disorder and/or mental health, in an addiction treatment facility
    • Physical Demands: Sitting for extended periods of time. Daily use of general office and/or residential facility equipment. Lifting (max 25 pounds), minimal reaching, bending and stooping. Ability to effectively navigate program or office environment such as ascending and descending steps, passing through doorways and entrances, and accessing program/office facilities.
    Preferred:
    • Minimum of 1 year experience performing utilization review tasks
    • Strong analytical and problem-solving skills
    • Strong facilitation, negotiation, investigation and mediation skills
  • 14 Days Ago

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Assistant HOME CARE Manager
  • American Family Care LLc
  • Rosemount, MN OTHER
  • ```Duties```- Provide comprehensive home management services to clients, ensuring their well-being and comfort.- Conduct patient assessments to determine individual needs and develop personalized care...
  • 19 Days Ago

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Pediatric Case Manager (non-clinical)- Home Health Care
  • 1st Choice Pediatric Home Care
  • Minneapolis, MN FULL_TIME,PART_TIME
  • 1st Choice Pediatric Home Care is seeking a hard working, empathetic, outgoing, and ambitious Pediatric Case Manager to advocate for our Pediatric Patients!Responsibilities: Advocate for Pediatric Pat...
  • 3 Days Ago

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Home Health Registered Nurse Case Manager
  • Senior Friend Home Care
  • Saint Paul, MN PART_TIME
  • Senior Friend Home Care, a specialty care home health provider is seeking a Registered Nurse for new client start of care visits in metro area and case management. Start of care RN is responsible for ...
  • 19 Days Ago

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Home Health Registered Nurse Case Manager
  • Senior Friend Home Care
  • Inver Grove Heights, MN PART_TIME
  • Senior Friend Home Care, a specialty care home health provider is seeking a Registered Nurse for new client start of care visits in metro area and case management. Start of care RN is responsible for ...
  • 19 Days Ago

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Home Care RN Case Manager
  • Adara Home Health
  • Ramsey, MN FULL_TIME
  • Why Work for Adara? Adara Home Health offers fulfilling Home Care careers to professionals looking for flexibility and the ability to manage their own schedule. Join our team and work for an employer ...
  • 8 Days Ago

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0 Utilization Review Manager - Home Care jobs found in Minneapolis, MN area

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Anesthesia Manager (CRNA) - Ambulatory Surgery Center - $30,000 Sign-on
  • University of Minnesota Physicians
  • Minneapolis, MN
  • University of Minnesota Physicians (M Physicians) is a non-profit organization seeking driven individuals in both clinic...
  • 3/28/2024 12:00:00 AM

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Patient Care Management Coordinator
  • Fairview Health Services
  • Minneapolis, MN
  • Overview: Are you an experienced nurse? We at M Health Fairview are looking for you to join our outstanding team! This b...
  • 3/28/2024 12:00:00 AM

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Store Manager
  • Rush Bowls - Minnetonka
  • Hopkins, MN
  • Job Description Job Description Are you passionate about healthy foods? Do you energize the people around you? Rush Bowl...
  • 3/27/2024 12:00:00 AM

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Project Manager 2
  • J. E. Dunn Construction Group
  • Minneapolis, MN
  • Best People + Right Culture. These are the driving forces behind JE Dunn's success. By hiring inspired people, giving th...
  • 3/27/2024 12:00:00 AM

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Clinical Pharmacist
  • Pride Health
  • Minneapolis, MN
  • Job Description Job Description Pride Health is hiring for a Clinical Pharmacist! (Remote Contract) Schedule: Monday-Fri...
  • 3/27/2024 12:00:00 AM

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Associate Director, Retail Media
  • TRANSACT
  • Minneapolis, MN
  • About the Company: Transact is Omnicom’s ecommerce specialty agency focused on connected commerce consulting and eRetail...
  • 3/27/2024 12:00:00 AM

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Assistant Meat Manager
  • Restaurant Depot LLC
  • Minneapolis, MN
  • Position Title: Assistant Meat Manager Department: Meat Supervisor: Meat Manager FLSA: Full-Time, Hourly, 8-10 hour shif...
  • 3/25/2024 12:00:00 AM

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Medical Director, Utilization Management - Remote
  • UnitedHealth Group Inc.
  • Minneapolis, MN
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 3/24/2024 12:00:00 AM

Minneapolis (/ˌmɪniˈæpəlɪs/ (listen)) is the county seat of Hennepin County and the larger of the Twin Cities, the 16th-largest metropolitan area in the United States. As of 2017, Minneapolis is the largest city in the state of Minnesota and 45th-largest in the United States, with an estimated population of 422,331. The Twin Cities metropolitan area consists of Minneapolis, its neighbor Saint Paul, and suburbs which altogether contain about 3.6 million people, and is the third-largest economic center in the Midwest. Minneapolis lies on both banks of the Mississippi River, just north of the riv...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$81,011 to $103,284
Minneapolis, Minnesota area prices
were up 1.4% from a year ago