Utilization Review Manager - Home Care jobs in Syracuse, NY

Utilization Management RN has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization Management RN is an integral part of the multidisciplinary team, and is highly efficient at communication to progress patients through the continuum of care based on their appropriate admission status. This individual will support the Utilization Management process by maintaining effective and efficient processes for determining appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.

This individual is responsible for concurrent and continued stay Utilization Management related reviews and functions and for ensuring that appropriate data is tracked, evaluated and reported. This individual leads and/or actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff.

This role effectively and efficiently manages a diverse workload in a fast paced, rapidly changing regulatory environment. The Utilization Management RN works collaboratively with a positive attitude with the Care team to promote timely progression throughout a patient’s stay.

Job Requirements:

Currently licensed as a Registered Nurse in New York State. Associates degree.  Bachelors degree preferred.  3-5 years acute hospital experience and 3-5 years exerpience Utilization management experience.  Hospital case management experience preferred.   Knowledge of federal and state (DOH, Medicaid/ Medicare) with knowledge of third party payers and/or managed care principles. 

Salary Range: $80,000

*Based on verified education & experience