Utilization Review Manager - Home Care jobs in the United States

Bachelor of Science in Nursing (BSN) OR Advanced Practitioner licensure

Experience

Seven (7) years diversified, progressive experience in acute care and/or other settings within the continuum required.

Two (2) years of Case Management which includes Utilization Review, Discharge Planning and working with Re-Admission Initiatives preferred.

Knowledge, Skills and Abilities

• Broad knowledge of medical treatment practices
• Knowledge of healthcare regulatory agency standards for health care organizations.
• Ability to operate independently and to balance multiple priorities.
• Strong interpersonal, and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professionals
• Knowledge of InterQual and/or Milliman criteria
• Skill in using computer software programs
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to resolve complex problems
• Ability to remain calm under pressure and intense time constraints
• Ability to assess discharge needs for patients

Licensures, Certifications

• Current state of Maryland Registered Nurse, Physician Assistant, or Nurse Practitioner license
• Certification in Utilization Management and/or Care Management highly desired.

Physical Requirements

• Ability to sit, stand, stoop, and bend.

Working Conditions

• Primarily in an office environment, evaluating electronic medical records and performing electronic documentation and communication 70% of time. Remainder of time working with interdisciplinary staff,

Conditions of Employment

• Maintain current licensure and certification