Engagement Manager, Data Aggregation
IntegriChain
SQL
Care Manager II, Utilization Management, Acute
Sutter Health
full-time
Posted on:
Location Type: Remote
Location: Remote • California, Illinois, Montana • 🇺🇸 United States
Visit company websiteSalary
💰 $79 - $103 per hour
Job Level
JuniorMid-Level
About the role
- Facilitate utilization management (UM) processes to support that the right care is provided at the right place and at the right time.
- Apply established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization and readiness for care transition.
- Assure timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as necessary.
- Provide third-party payers clinical information to assure reimbursement.
- Coordinate care with the treatment team, patient, family and others as necessary.
Requirements
- Graduate of an accredited school of nursing
- RN-Registered Nurse of California Upon Hire
- 2 years recent relevant experience
- Demonstrates basic knowledge of the role of UM, Care Transition and/or CM for patients within an acute hospital and/or ED setting
- Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, all value-based reimbursement models, and alternative payment systems preferred
- Working knowledge of laws, regulations and professional standards affecting case management practice
- A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements
- Must be able to effectively communicate with, and promote cooperation and collaboration between individuals
- Demonstrates ability to efficiently and independently manage own time and tasks with minimal supervision
- General understanding of coding and DRG assignment process preferred
- Excellent verbal and written communication skills required
- Must be able to communicate effectively with a wide variety of personalities and departments
- Ability to read, write, hear, and communicate verbally in English to the degree required to perform the job
- Willingness to act and dress in a professional manner at all times
- Proficient in using a computer to accurately enter and extract data, send and receive email
- Proficient in the use and application of evidence-based level of care and medical necessity criteria such as InterQual and/or MCG
- Must be able to meet accuracy and productivity requirements by the organization standards.
- Maintain proficiency in conducting utilization reviews using MCG/InterQual by keeping up with practices and technology, participating in all training and education requirements, and certification or accreditation as applicable.
- Ability to use Microsoft Office Suite products (Outlook, Word, Excel, Power Point) preferred.
Benefits
- Yes 📊 Resume Score Upload your resume to see if it passes auto-rejection tools used by recruiters Check Resume Score
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization managementcare transitioncase managementcodingDRG assignmentevidence-based criteriaInterQualMCGhealthcare reimbursement systemsregulatory compliance
Soft skills
communicationcollaborationtime managementindependenceprofessionalismverbal communicationwritten communicationcooperationproblem-solvinginterpersonal skills
Certifications
RN-Registered Nurse of California
