Utilization Care Manager - Rn

it.osu.edu

Remote
Fully remote
Utilization management program
Medical necessity guidelines
Compliance with cms guidelines
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 while maintaining awareness of healthcare trends and regulatory standards.
  • 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

  • Utilization Management Program
  • Medical necessity guidelines
  • Compliance with CMS guidelines
  • Knowledge of payer rules and regulations
  • Application of MCG guidelines

Nice-to-have

  • Awareness of State and National healthcare trends
  • Familiarity with TJC and third party payor guidelines
  • Remote work environment

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter