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UM Case Manager – Utilization Management
McLeod HealthUM Case Manager at McLeod Health coordinating patient care through acute settings and ensuring reimbursement processes. Responsible for quality assurance and improvement in care.
About the role
Key responsibilities & impact- Coordinates/facilitates patient care progression throughout the continuum of care.
- Assures the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
- Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered.
- Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas.
- Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors.
- Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form.
- Ensures that all payer communication is documented for the care team as well as billing.
- Ability to cover various populations across the organization in relation to Utilization Review.
- Performs all other duties as requested by Case Manager Supervisor and/or Director.
Requirements
What you’ll need- 1-2 years of recent acute care hospital experience required
- Data entry/computer experience required
- Registered Nurse
Benefits
Comp & perks- Health insurance
- Retirement plans
- Paid time off
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
patient care coordinationutilization reviewdata entrymedical necessity documentationlength of stay monitoringancillary resource managementcase managementquality improvementrisk managementreimbursement processes
Soft Skills
communicationinterpersonal skillsorganizational skillsproblem-solvingteam collaborationattention to detailadaptabilitypatient focuscritical thinkingleadership
Certifications
Registered Nurse