We’re proud to be an EEO/AA employer M/F/D/V. Minority and ladies are inspired to use. We keep a drug-free & nicotine free office and carry out pre-employment substance abuse testing.
Basic Description:
Works beneath basic supervision, to guarantee value efficient, high quality utilization management within the acute degree of care setting. Assessment medical info offered by amenities and communicates UM determinations sustaining timeliness.
Key Job Necessities:
Schooling: Licensed Registered Nurse, should have an lively license to follow skilled nursing within the Commonwealth of Pennsylvania., 2 years medical/surgical, utilization evaluation, emergency room, and homecare/DME authorization expertise. BSN most popular.
Expertise/Talents: Should current polished skilled picture. Information of HMO supply methods. Capacity to work and talk successfully with co-staff, members and suppliers on the proprietor establishments. Have to be organized, detailed oriented, and able to dealing with a number of points. Wonderful phone and verbal/written communication expertise. Pc literate.
Main Duties:
- Evaluate and monitor emergency admissions to determine applicable degree of care.
- Carry out concurrent assessment and/or admission assessment on all hospital admissions utilizing InterQual standards tips.
- Monitor assigned instances for well timed evaluations/updates and selections as mirrored in case documentation.
- Request and assessment medical data to determine applicable acute care days and approve or refer questionable days to the medical director for choice.
- Perform as a liaison between suppliers, members and interdepartmentally.
- Function useful resource for physicians, PCPs, Utilization Evaluate departments and all medical suppliers.
- Determine developments that influence on utilization at hospitals in the course of the evaluate course of and assist resolve them.
- Keep departmental and regulatory timeframes for utilization selections.
- Contributes to the event and enhancement of documentation, monitoring instruments and course of flows.
- Maintains collaborative and efficient cross- useful coaching inside the Utilzation Management Division Utilzation management carry out after hours on-name protection.
- Participates in related work teams and supply deliverables as crucial.
- Profitable and well timed completion of assignments in accordance with departmental and Firm operational goals and seeks suggestions on efficiency. Ensures that assignements are scheduled and accomplished in an correct and well timed method.
- Maintains detailed information of the standing of all assignments and routinely updates the supervisor, as applicable.
- Performs all different duties as assigned.
Medicare Benefit Compliance Assertion: Compliance with all relevant guidelines, laws and legal guidelines is a situation of employment. Staff should learn and signal, each the Enterprise Code of Conduct and the Private Commonplace Code of Conduct, and are anticipated to carry out their duties ethically and truthfully.
Entry To Protected Health Info: UMN
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