The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by determining appropriateness for inpatient level of care or observation services based on documented clinical information
Job Summary
The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by determining appropriateness for inpatient level of care or observation services based on documented clinical information.
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.
The position is remote, scheduled for 40 hours per week on the first shift, and final candidates are subject to background checks and possibly drug screening or physical exams.
Matching Summary
The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by determining appropriateness for inpatient level of care or observation services based on documented clinical information.
Skills & Requirements
Must-have
Utilization Management Program
Medical necessity guidelines
Compliance with CMS guidelines
Knowledge of payer rules and regulations
Remote work
Nice-to-have
Awareness of State and National healthcare trends
Familiarity with TJC and third party payor guidelines
Care Management Services experience
Key Requirements
Bachelor's degree in Nursing
RN licensure
Two years of Care Management and/or Utilization Management experience