Utilization Review Manager - Home Care jobs in Mississippi
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
RN-Utilization Review - DC Case Management Admin BMH Desoto
- Baptist
-
Southaven, MS
FULL_TIME
-
Summary
The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance companies and patients to ensure cost-effective and appropriate care. Areas of work include status management, medical necessity reviews, verification of authorization, resource utilization, and denial prevention.
Responsibilities- Completes and enters inpatient and observation admission review against standard criteria per payer guidelines
- Prioritizes observation case review
- Assists with level of care in collaboration with attending provider
- Enters working diagnosis-related groups (DRGs) in the electronic medical record
- Submits clinical information to payer per payer requirements
- Completes continued stay reviews every 3 days or more often if required
- Communicates with care coordinators for authorized days, level of care, medical necessity or other areas when indicated
- Communicates with physician advisors related to status concerns or denials
- Updates auth/cert screen in the electronic medical record
- Works assigned queues in the electronic medical record
- Communicates with authorization coordinator
- Communicates in-house high dollar case information
Completes assigned goals
Requirements, Preferences and Experience
Experience Minimum:
RN with 3 years of clinical experience
Experience Preferred:
RN with 3 years of clinical experience
Education Minimum:
Diploma or Associate Degree in Nursing
Education Preferred:
BSN or MSN
Special Skills Minimum:
Critical thinking skills, clinical knowledge, attention to detail communication, organization, interpersonal, time management and computer skills. Problem solving; and knowledge of governmental regulations.
Licensure Minimum:
RN
Licensure Preferred:
CCM;ACM
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.
At Baptist, We Offer:- Competitive salaries
- Paid vacation/time off
- Continuing education opportunities
- Generous retirement plan
- Health insurance, including dental and vision
- Sick leave
- Service awards
- Free parking
- Short-term disability
- Life insurance
- Health care and dependent care spending accounts
- Education assistance/continuing education
- Employee referral program
Job Summary:
Position: 18447 - RN-Utilization Review
Facility: BMH - Desoto Hospital
Department: DC Case Management Admin BMH Desoto
Category: Nurse RN
Type: Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:MS:Southaven
Located in the Memphis metro area - 20 Days Ago
Patient Care Manager
- Kindred at Home
-
Jackson, MS
FULL_TIME
- Requisition ID: 2024-97337 Position Division: Hospice Only Location: Gentiva Hospice Category: Clinical Requisition Post Information* : External Company Name: Gentiva Position Type: Full-Time Location...
- 17 Days Ago
Hiring Manager
- FirstLight Home Care
-
Petal, MS
FULL_TIME
- The Hiring Manager is responsible for hiring, on-boarding and training care team staff. This individual directly interfaces with applicants to determine a good fit for our exceptional care team. Quali...
- 17 Days Ago
RPCA Quality Assurance & Review Manager
- Hub International
-
Ridgeland, MS
OTHER
- RPCA Quality Assurance and Review Manager Job Description Primary responsibilities Independently manage the review process for 300 plus retirement plans – compliance testing, calculations, and governm...
- 13 Days Ago
In Home Caregiver
- Salus Home Care, LLC
-
Biloxi, MS
PART_TIME,FULL_TIME
- Salus Home Care is seeking full-time AND part-time caregivers for all shifts! Receive valuable benefits while making a difference in people's lives. Do you want to make a difference? Do you want to jo...
- 11 Days Ago
RN Care Manager
- North Mississippi Medical Center Home Health
-
Tupelo, MS
FULL_TIME
- Job Description Clinical Practice: Uses the nursing process to provide safe, quality patient care and document accordingly. Works to ensure his/her compliance with all NMHS policies and requirements a...
- Just Posted
Utilization Review Manager - Home Care jobs at Popular Companies
Utilization Management Manager
- Medasource
-
Fresno, CA
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-
Mayetta, KS
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-
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- A Brief Overview The Utility Management Director is responsible for providing leadership, direction and guidance as it p...
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-
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- Job Title: Interim Case Management Manager Client: Large Healthcare Provider Location: Fresno, California Start Date: AS...
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-
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- We are seeking a highly skilled and experienced Utility Manager to oversee the operation and maintenance of utility syst...
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-
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- Hunt MH Shared Services LLC Utility Management Director Seattle , Washington Apply Now DescriptionA Brief OverviewThe Ut...
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- We recognize that our success depends on the quality of the people we hire. We are currently seeking highly talented ind...
- 4/23/2024 12:00:00 AM
About Mississippi
Mississippi is bordered to the north by Tennessee, to the east by Alabama, to the south by Louisiana and a narrow coast on the Gulf of Mexico; and to the west, across the Mississippi River, by Louisiana and Arkansas.
In addition to its namesake, major rivers in Mississippi include the Big Black River, the Pearl River, the Yazoo River, the Pascagoula River, and the Tombigbee River. Major lakes include Ross Barnett Reservoir, Arkabutla Lake, Sardis Lake, and Grenada Lake with the largest lake being Sardis Lake.
Mississippi is entirely composed of lowlands, the highest point being Woodall Mountai...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$68,025 to $86,726