CasperRecruiter Since 2001
the smart solution for Casper jobs

Utilization Review Specialist - Care Management - Saturday & Sunday Only!

Company: Wyoming Medical Center
Location: Casper
Posted on: August 2, 2019

Job Description:

As a pivotal partner within the health care delivery team, the Utilization Specialist will review charts using Interqual criteria to determine medical necessity of admission and ongoing stay within the hospital.

Duties& Responsibilities:


  • The employee shall comply with all safety and health standards, and all rules, regulations, and orders which are applicable to the individual's own position, actions, and conduct.
  • Performs chart reviews in line with current standards and guidelines. These requirements include but are not limited to: Utilization of Interqual ISD Acute Level of Care Criteria for all patient types; Documenting quality indicators for the inpatient population; and Monitoring for appropriate use of patient status (e.g. inpatient/observation).
  • Maintains and applies current knowledge of requirements for insurance providers and special needs associated with Medicaid, Medicare, Workers Compensation, Veterans Administration, and other major programs.
  • Maintains and applies knowledge and clear understanding of full array of hospital processes and care decisions from admission to discharge.
  • Initiates notifications to and telephone reviews with third party payers.
  • Informs inpatient unit manager of patient specific concerns arising from reviews, and keeps Executive Director and/or other appropriate staff informed of special circumstances relating to care utilization.
  • Makes referrals to Physician Reviewer and/or to second-level reviewers as appropriate.
  • Completes appropriate and standardized documentation in Midas and/or other relevant software applications to ensure accurate and timely data and patient records.
  • Assists Case Manager with Hospital Initiated Notice of Non-Coverage (HINN) actions as appropriate.
  • Participates as necessary to develop and implement process improvements (including Lean initiatives) for quality, satisfaction, and revenue maximization. Provides assistance in UR process improvements.
  • Maintains and applies knowledge of current regulatory standards and requirements as set forth by Mountain Pacific Quality Health Foundation or other relevant regulatory and/or accreditation agencies.
  • Processes denial and appeal notices in a timely manner.
  • Works collaboratively with other members of the Care Continuum team to achieve best appropriate care for each patient.
  • Notifies physician(s) of care continuum issues related to insurable coverage.
  • Works with Case Managers to conduct daily collaborative rounds as necessary.
  • Serves as expert resource and provides education to all Case Managers on Utilization Reviews and UR-related requirements.


    Requirements


    • --- Prior Utilization Review experience is preferred.
    • --- At least five years of job-relevant acute care nursing experience is required.

Keywords: Wyoming Medical Center, Casper , Utilization Review Specialist - Care Management - Saturday & Sunday Only!, Executive , Casper, Wyoming

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Director of Operations - Own a Franchise
Description: Directors of Operations: Make
Company: CMP.jobs
Location: Casper
Posted on: 08/9/2019

-Casper, WY / Pain Management / 2800 injections per year
Description: Pain Management opening in Casper, Wyoming. This and other physician jobs brought to you by DocCafe.com Pain Management br Casper, WYPosition is full-time, permanent, employed. Seeking
Company: Keith A. Long LLC, dba. Source Medical
Location: Casper
Posted on: 08/10/2019

Utilization Review Specialist - Care Management - Saturday & Sunday Only!
Description: As a pivotal partner within the health care delivery team, the Utilization Specialist will review charts using Interqual criteria to determine medical necessity of admission and ongoing stay within the (more...)
Company: Wyoming Medical Center
Location: Casper
Posted on: 08/11/2019


Director of Information Security
Description: In compliance with the Health Insurance Portability and Accountability Act of 1996 HIPAA and good security practice, Wyoming Medical Center is responsible for appointing a health information security (more...)
Company: Wyoming Medical Center
Location: Casper
Posted on: 08/2/2019

Acute Care Service Line Director(RN-MedSurg and Womens Health)
Description: TITLE: ACUTE CARE SERVICE LINE DIRECTOR MedSurg and Womens Health br LOCATION: Casper, WY br br Would you be interested in living in an area with a historic downtown district with numerous art (more...)
Company: Job Juncture
Location: Casper
Posted on: 08/8/2019

Sales Management Trainee
Description: If youre looking to start your career with a company that grows their managers and leaders from within the organization, then the Enterprise Management Training Program is for you. Whether you see yourself (more...)
Company: Enterprise
Location: Casper
Posted on: 08/6/2019

Facilities Director
Description: Facilities DirectorFT
Company: YMCA of Natrona County
Location: Casper
Posted on: 08/1/2019

Director of Business Development - Own a Franchise
Description: Director of Business Development:
Company: CMP.jobs
Location: Casper
Posted on: 08/17/2019

Sales Management Trainee
Description: If youre looking to start your career with a company that grows their managers and leaders from within the organization, then the Enterprise Management Training Program is for you. Whether you see yourself (more...)
Company: Enterprise Rent-A-Car
Location: Casper
Posted on: 08/18/2019

Utilization Review Specialist - Care Management - Saturday & Sunday Only!
Description: As a pivotal partner within the health care delivery team, the Utilization Specialist will review charts using Interqual criteria to determine medical necessity of admission and ongoing stay within the (more...)
Company: Wyoming Medical Center
Location: Casper
Posted on: 08/2/2019

Log In or Create An Account

Get the latest Wyoming jobs by following @recnetWY on Twitter!

Casper RSS job feeds