Lifespan
Utilization Care Manager
Lifespan, Providence, Rhode Island, us, 02912
Utilization Care Manager - RN License Required
Lifespan
Providence, Rhode Island
Lifespan is Rhode Island’s largest health system and private employer dedicated to improving the health of all people within our communities. We are seeking a part-time
Utilization Care Manager
to join us at The Miriam Hospital in Providence, RI. In this position, you will ensure the appropriate and timely utilization of resources and services to provide patients with high quality, safe and fiscally responsible care.
Responsibilities:
Ensure the appropriate level of patient care is provided and that admission and concurrent authorizations from third-party payers are obtained.
Review all admissions and proactively provide clinical information to third-party payers to support level of care.
Act as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow-up.
Review all Medicare patient admissions and ensure the appropriate level of care for patients per Medicare and insurance regulatory guidelines.
Deliver Hospital Issued Notice of Non-coverage (HINN) to Medicare Beneficiaries when acute inpatient admission is not medically necessary.
Educate members of the healthcare team regarding Medicare and regulatory guidelines regarding appropriate levels of care, the HINN delivery and the patient appeal process.
Qualifications:
Bachelor’s degree in nursing required; master’s degree preferred.
Current licensure to practice as RN in the State of Rhode Island.
Certified Professional in Healthcare Management (CPHM) is highly desirable.
5+ years of clinical experience with recent experience in utilization review case management, patient navigation and/or discharge planning is preferred.
Familiarity with InterQual care management criteria with high level of knowledge concerning utilization review healthcare finance and the requirements of relevant payers.
Proficient in the use of Microsoft Office.
Strong analytical, communication and interpersonal skills.
Demonstrated knowledge and skills necessary to provide care to patients throughout the life span with consideration of aging processes, human development stages and cultural patterns.
Working at Lifespan:
At Lifespan, we utilize a multidisciplinary team approach to medicine and provide the right blend of autonomy and collaboration. If you share our passion for providing the very best care in a supportive professional setting, join one of the nation’s Top 100 health systems. Consistently awarded Magnet status in nursing care, Lifespan is committed to clinical excellence and devoted to our mission of delivering health with care.
Job Type:
Part-time
Benefits:
401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:
Day shift
Work Location:
In person
#J-18808-Ljbffr
Lifespan
Providence, Rhode Island
Lifespan is Rhode Island’s largest health system and private employer dedicated to improving the health of all people within our communities. We are seeking a part-time
Utilization Care Manager
to join us at The Miriam Hospital in Providence, RI. In this position, you will ensure the appropriate and timely utilization of resources and services to provide patients with high quality, safe and fiscally responsible care.
Responsibilities:
Ensure the appropriate level of patient care is provided and that admission and concurrent authorizations from third-party payers are obtained.
Review all admissions and proactively provide clinical information to third-party payers to support level of care.
Act as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow-up.
Review all Medicare patient admissions and ensure the appropriate level of care for patients per Medicare and insurance regulatory guidelines.
Deliver Hospital Issued Notice of Non-coverage (HINN) to Medicare Beneficiaries when acute inpatient admission is not medically necessary.
Educate members of the healthcare team regarding Medicare and regulatory guidelines regarding appropriate levels of care, the HINN delivery and the patient appeal process.
Qualifications:
Bachelor’s degree in nursing required; master’s degree preferred.
Current licensure to practice as RN in the State of Rhode Island.
Certified Professional in Healthcare Management (CPHM) is highly desirable.
5+ years of clinical experience with recent experience in utilization review case management, patient navigation and/or discharge planning is preferred.
Familiarity with InterQual care management criteria with high level of knowledge concerning utilization review healthcare finance and the requirements of relevant payers.
Proficient in the use of Microsoft Office.
Strong analytical, communication and interpersonal skills.
Demonstrated knowledge and skills necessary to provide care to patients throughout the life span with consideration of aging processes, human development stages and cultural patterns.
Working at Lifespan:
At Lifespan, we utilize a multidisciplinary team approach to medicine and provide the right blend of autonomy and collaboration. If you share our passion for providing the very best care in a supportive professional setting, join one of the nation’s Top 100 health systems. Consistently awarded Magnet status in nursing care, Lifespan is committed to clinical excellence and devoted to our mission of delivering health with care.
Job Type:
Part-time
Benefits:
401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:
Day shift
Work Location:
In person
#J-18808-Ljbffr