Utilization Review Manager - Home Care jobs in Rock Hill, SC
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 PRN Days
- Piedmont Medical Center
-
Rock Hill, SC
OTHER
-
RN Utilization Review PRN Days Position SummaryThe individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis.This position integrates national standards for case management scope of services including:- Utilization Management services supporting medical necessity and denial prevention- Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient- Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy- Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits- The individual’s responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c) managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e) timely, complete and concise documentation in the Tenet Case Management documentation system, f) maintenance of accurate patient demographic and insurance information, g) identification and documentation of potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as assigned.THE RN UTILIZATION PRN DAYS REVIEW CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.Education Preferred: BSNRequired qualifications include an active Registered Nurse license with at least two years acute hospital or Behavioral Health patient care experience. BSN preferred (unless required * if Magnet Hospital). Accredited Case Manager (ACM) preferred.Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to work in a fast paced environment, critical thinking and problem solving skills and computer literacy.Required: Active and valid RN license.Preferred: Accredited Case Manager (ACM).2403012592
- 1 Day Ago
Utilization Review Specialist - Part-time
- Acadia Behavioral Health (Pioneer Behavioral Health)
-
Lancaster, SC
PART_TIME
- Employment Type: Part-Time Hours Per Week: 1 The Utilization Review Specialist at Rebound Behavioral Health will be responsible for conducting initial and concurrent reviews while reviewing clinical d...
- 2 Months Ago
Utilization Review Specialist - Part-time
- Rebound Behavioral Health
-
Lancaster, SC
PART_TIME
- The Utilization Review Specialist at Rebound Behavioral Health will be responsible for conducting initial and concurrent reviews while reviewing clinical documentation for the stay of the patient. Reb...
- 2 Months Ago
Home Care Business Development Manager
- ComForCare Home Health Care - Suburban Metrolina
-
Rock Hill, SC
FULL_TIME
- Benefits: Bonus based on performance Competitive salary Flexible schedule Opportunity for advancement Profit sharing Training & development Live your best life possible by helping others live theirs. ...
- 15 Days Ago
Home Care Office Manager/Marketer
- Live Long Well Care
-
Tega Cay, SC
FULL_TIME
- Live Long Well Care of Tega Cay is now accepting applications for an experienced Home Care Office Manager/Marketer (Client Service Manager). This management position is responsible for supporting the ...
- 1 Month Ago
Home Care Office Manager Marketer/Client Service Manager
- Live Long Well Care
-
Tega Cay, SC
FULL_TIME
- Live Long Well Care of Tega Cay is now accepting applications for a Office Manager Marketer/Client Service Manager. This management position is responsible for marketing and managing our local Tega Ca...
- 12 Days Ago
Filters
- Current Active Filter
- Rock Hill, SC
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Utilization Review Manager - Home Care jobs found in Rock Hill, SC area
Store Manager
- Enzo's Italian Market
-
Rock Hill, SC
- Job Description Job Description Store Manager - Job Details Salary $17 - $21 per hour Available Shifts Day shift, 8-hour...
- 4/18/2024 12:00:00 AM
Data Analyst
- Insight Global
-
Rock Hill, SC
- Required Experience: Core ERP System Support: Experience with ERP Software SQL Expertise: Expert level skills in SQL, in...
- 4/18/2024 12:00:00 AM
Sr Product Manager - UM/CM/Rx - Remote ($135K)
- Confidential
-
Charlotte, NC
- Remote potential | Green Card or Citizen requirement This Sr. Product Manager will support customer implementation of ou...
- 4/18/2024 12:00:00 AM
Data Analyst
- Insight Global
-
Rock Hill, SC
- Required Experience: Core ERP System Support: Experience with ERP Software SQL Expertise: Expert level skills in SQL, in...
- 4/17/2024 12:00:00 AM
Oracle Utilities Manager
- Accenture
-
Charlotte, NC
- We are: Accentures Oracle practice, and we make the new happen now. Every day, we imagine the future and bring it to lif...
- 4/14/2024 12:00:00 AM
Shift Leader - Part-Time
- Zaxby's
-
Indian Land, SC
- As the team at Zaxby's expands, we're saving a seat for you! To our guests, Zaxby's is more than just a place to eat - i...
- 4/8/2024 12:00:00 AM
Shift Leader - Full-Time
- Zaxby's
-
Indian Land, SC
- As the team at Zaxby's expands, we're saving a seat for you! To our guests, Zaxby's is more than just a place to eat - i...
- 4/8/2024 12:00:00 AM
Restaurant Assistant Manager
- Zaxby's
-
Indian Land, SC
- As the team at Zaxby's expands, we're saving a seat for you! To our guests, Zaxby's is more than just a place to eat - i...
- 4/8/2024 12:00:00 AM
About Rock Hill, South Carolina
Rock Hill is the largest city in York County, South Carolina, United States and the fifth-largest city in the state. It is also the fourth-largest city of the Charlotte metropolitan area, behind Charlotte, Concord, and Gastonia (all located in North Carolina, unlike Rock Hill). As of the 2010 Census, the population was 66,154. In 2016, the population had increased to 72,937.
The total population of Rock Hill inside the city limits and outside the city limits as of 2017 was estimated at 117,375 people.
The city is located approximately 25 miles (40 km) south of Charlotte and approximately 70 mi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$73,821 to $94,115
Rock Hill, South Carolina area prices
were up 1.5% from a year ago
were up 1.5% from a year ago