Utilization Review Manager - Home Care jobs in New Hampshire
Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
Recently Added Utilization Review Manager - Home Care jobs
Elliot Health Systems - RN Utilization Review - Care Coordination - Per Diem
- SolutionHealth
-
Manchester, NH
PER_DIEM
-
Come work at the best place to give and receive care!
Job Description
Who We Are:
The Care Coordination Department at the Elliot Hospital takes great pride in serving their community, patients, and families. Our Utilization RN’s observe best practices and strive to attain the best outcomes possible for their patients. If you are a nurse with strong clinical experience/skills, please consider our department! We will do on the job training for experienced Nurses who meet the requirements below! Apply today!
About The Job
The Utilization Review RNs (UR RN) primary responsibility is to monitor adherence to the hospital’s utilization review plan to ensure the effective and efficient use of hospital services. The Utilization Review RN will utilize medical necessity screening tools, such as InterQual, to complete admission reviews in determining appropriate level of care; and will document continued stay reviews for continued need for inpatient care, appropriateness of tests and procedures, and an estimation of the patient's expected length of stay. And more.
What You’ll Do- Screens all patients admitted to Elliot Hospital either on admission or next business day to determine the appropriate level of care
- Identifies and monitors observation status patients concurrently to ensure appropriate utilization of observation status
- Performs concurrent reviews for patients to ensure that extended stays are medically justified
- Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued stay
- Obtains timely insurance authorization/certifications from all payers requiring authorization of hospitalizations, test, procedures, medications, etc
- Maintains knowledge of current Federal, State and payer regulatory requirements pertinent to utilization review processes
- Bachelor's degree in a healthcare-related field or equivalent experience
- Current BSN or commitment to achieving the degree in a specified amount of time
- A minimum of three (3) years hospital case management or utilization management experience , Required.
- CCM or ACM preferred
- Excellent clinical documentation, and successful usage of EMR systems, Preferred
- Health, dental, prescription, and vision coverage for full-time & part-time employees
- Short term, long term disability, Accident insurance, & life insurance
- Tuition Reimbursement
- Referral bonuses
- Accrued earned time for full-time & part-time employees
- 403b Retirement plans, with generous employer contributions
- And more!
Work Shift
First - Days
SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law. - 10 Days Ago
Utilization Review RN - Per DIem
- Wentworth-Douglass Hospital
-
Dover, NH
PER_DIEM
- Days 7:30am -4:00pm No Holidays Weekend rotation Remote after fully trained Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teachi...
- 3 Days Ago
Registered Nurse - Utilization Review Coordinator
- Exeter Hospital
-
Exeter, NH
PER_DIEM
- Hybrid opportunity, must be local to Exeter, NH Exeter Hospital, Core Physicians, and Rockingham VNA & Hospice, part of Beth Israel Lahey Health, proudly serve the beautiful NH seacoast region. Our pr...
- 10 Days Ago
RN Case Manager Home Care
- SolutionHealth Home Health & Hospice Care
-
Merrimack, NH
FULL_TIME
- Why Work For Us? Home Health & Hospice Care is one of the oldest Visiting Nurse Agencies in the country tracing our roots to Nashua NH! Staff are proud to say "I work for Home Health & Hospice Care". ...
- 9 Days Ago
Utilization Review RN - Days M-F -Hybrid
- Wentworth-Douglass Hospital
-
Dover, NH
FULL_TIME
- Days 7:30am -4:00pm Weekends and Holidays are Optional Remote after fully trained - (90 days or more) Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting pati...
- 3 Days Ago
Utilization Review RN - Per Diem -Hybrid
- Wentworth-Douglass Hospital
-
Dover, NH
PER_DIEM
- Days 7:30am -4:00pm No Holidays Some weekend rotation Remote after fully trained Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, t...
- 3 Days Ago
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- Leprino Foods
-
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-
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Director Utilization Management
- Heritage Valley Health System, Inc.
-
Beaver, PA
- Department: Utilization Review. Work Hours: Primarily Monday through Friday, extended hours as needed to support organiz...
- 6/9/2024 12:00:00 AM
Supervisor, Utilization Management
- Centene Corporation
-
Tallahassee, FL
- You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Managem...
- 6/9/2024 12:00:00 AM
Utilization Management Specialist
- Blue Cross and Blue Shield Association
-
Meridian, ID
- Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, pri...
- 6/9/2024 12:00:00 AM
Director of Utilization Management
- Oceans Healthcare
-
Jackson, MS
- Description The Director Utilization Management is responsible for oversight and management of all utilization review/ca...
- 6/8/2024 12:00:00 AM
Manager, Utilization Management
- Hiring Now!
-
New York, NY
- Creates and upholds policies and procedures for coverage determinations. Serves as subject matter expert for Medicare co...
- 6/8/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Health System
-
Beaver, PA
- Department: Utilization Review Work Hours: Primarily Monday through Friday, extended hours as needed to support organiza...
- 6/7/2024 12:00:00 AM
About New Hampshire
New Hampshire is part of the six-state New England region. It is bounded by Quebec, Canada, to the north and northwest; Maine and the Atlantic Ocean to the east; Massachusetts to the south; and Vermont to the west. New Hampshire's major regions are the Great North Woods, the White Mountains, the Lakes Region, the Seacoast, the Merrimack Valley, the Monadnock Region, and the Dartmouth-Lake Sunapee area. New Hampshire has the shortest ocean coastline of any U.S. coastal state, with a length of 18 miles (29 km), sometimes measured as only 13 miles (21 km). New Hampshire was home to the rock forma...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$77,884 to $99,290