Utilization Care Manager - Rn

cspam.osu.edu

Remote
Fully remote
Medical necessity guideline application
Knowledge of cms and payer requirements
Utilization management program contribution
The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services

Job Summary

  • The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services.
  • This role requires in-depth knowledge and ability to apply various payer rules, regulations and MCG guidelines in compliance with CMS and other payer requirements.
  • Final candidates are subject to successful completion of a background check and may require a drug screen or physical during the post offer process.

Matching Summary

The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services.

Skills & Requirements

Must-have

  • Medical necessity guideline application
  • Knowledge of CMS and payer requirements
  • Utilization management program contribution
  • Compliance with MCG guidelines
  • Remote work capability

Nice-to-have

  • Awareness of State and National healthcare trends
  • Understanding of TJC and third party payor guidelines
  • Experience with hospital utilization management

Key Requirements

  • Bachelor's degree in Nursing
  • RN licensure
  • Two years of Care Management and/or Utilization Management experience

Work Rights

Not specified

Tailored Resume

Cover Letter