Utilization Review Manager - Home Care jobs in Louisiana
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
Utilization Review Manager
- Ochsner Health
-
Lafayette, LA
FULL_TIME
-
This job manages the daily operations of all assigned divisions within the case management department in collaboration with the case management and social services leadership. Manages plans and organizes all business functions including staffing, staff development, training, purchasing, and budgeting. Manages initiatives to improve processes, maximize efficiency, satisfy internal and external customers, maintain high employee morale, empower, and serve respective teams.To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.Education:
- Required - Bachelors degree in nursing (BSN).
OR- Master's degree in social work (MSW).
Work Experience:- Required - 3 years of case management experience in an acute care setting or similar environment.
- Experience in compliance management systems (CMS) regulations, compliance and quality metrics.
- Experience managing denials and appeals of all payer cases in a timely and organized manner.
- Preferred - 1 year of management level experience.
- Experience in managed care, quality management, regulatory compliance, medical management, or other related MCO departments/functions.
Certifications:- Required - Current registered nurse (RN) license in state of practice.
- *MSW accepted in lieu of registered nurse (RN) licensure.
- Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare Management (CPHM).
Knowledge Skills and Abilities (KSAs):- Proficiency in using computers, software, and web-based applications.
- Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
- Conflict resolution skills and ability to demonstrate good judgement in performing duties.
- Knowledge of business management principles including operations, finance, audit, authorizations, referrals, discharge planning, personnel, and resource management.
- Understanding of financial statements and ability to manage within a budget, analyze trends, and make recommendations.
- Must be able to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability)
Job Duties:- Leads respective teams with high motivation and responsibility for the welfare of the entire team making decisions based on good judgement rather than popularity.
- Promotes, supports, encourages, and fosters maximum communication across case management with the purpose of making one accessible and available to all team members ensuring that effective problem analysis is exercised across all levels of the organization.
- Conducts personal leadership self-development with the conscious intention to always become a better, more effective leader.
- Manages the implementation controls for all precertification, continued stay, authorization and billing processes as well as policies and procedures required for success under the direction of the case management leadership.
- Leads special and audit projects independently with the end goal of ensuring that the internal control environment is not compromised and the awareness of the process control culture is increasingly heightened.
- Determines appropriate staffing levels and the interviewing, hiring, performance review, and termination of employees within practice unit(s); maintains employee schedules to assure appropriate coverage.
- Develops departmental specific systems to assure an environment that emphasizes patient courtesy and responsive service delivery.
- Performs other related duties as required.
The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.
#LI-SF1 - 1 Month Ago
RN Utilization Manager - PRN - OLGMC - Utilization Review
- Ochsner Lafayette General
-
Lafayette, LA
FULL_TIME
- We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every re...
- 8 Days Ago
DIRECTOR - UTILIZATION REVIEW / MGMT
- Universal Health Services, Inc.
-
Harahan, LA
FULL_TIME
- Responsibilities River Oaks Hospital, located in metropolitan New Orleans, Louisiana, is a private psychiatric facility for adults, adolescents and children. Since 1970, River Oaks has established a t...
- 8 Days Ago
Utilization Review RN
- Blue Cross and Blue Shield of Louisiana
-
Baton Rouge, LA
CONTRACTOR
- We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to appl...
- 10 Days Ago
DIRECTOR - UTILIZATION REVIEW / MGMT
- UHS
-
HARAHAN, LA
FULL_TIME
- Responsibilities River Oaks Hospital, located in metropolitan New Orleans, Louisiana, is a private psychiatric facility for adults, adolescents and children. Since 1970, River Oaks has established a t...
- 14 Days Ago
DIRECTOR - UTILIZATION REVIEW / MGMT
- River Oaks Hospital
-
Harahan, LA
FULL_TIME
- Responsibilities: River Oaks Hospital, located in metropolitan New Orleans, Louisiana, is a private psychiatric facility for adults, adolescents and children. Since 1970, River Oaks has established a ...
- 14 Days Ago
Utilization Review Manager - Home Care jobs at Popular Companies
PSM & Utility Manager
- Land O'Lakes, Inc.
-
Spencer, WI
- PSM & Utility Manager The PSM & Utilities Manager is responsible for managing plant utilities and ammonia refrigeration ...
- 6/11/2024 12:00:00 AM
Gas Utilities Manager
- Accenture
-
Austin, TX
- We Are: Our Utility Industry, Transmission & Distribution Practice is powering the progress to a safe, connected, and su...
- 6/10/2024 12:00:00 AM
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 Louisiana
Louisiana is bordered to the west by Texas; to the north by Arkansas; to the east by Mississippi; and to the south by the Gulf of Mexico.
The state may properly be divided into two parts, the uplands of the north, and the alluvial along the coast.
The alluvial region includes low swamp lands, coastal marshlands and beaches, and barrier islands that cover about 20,000 square miles (52,000 km2). This area lies principally along the Gulf of Mexico and the Mississippi River, which traverses the state from north to south for a distance of about 600 mi (970 km)) and empties into the Gulf of Mexico; ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$72,830 to $92,846