Case Manager – Utilization Review, reputed company

R0058241 Department: OUMC Utilization Review Job reputed company: General reputed company: Conducts reputed company Medical necessity review for patients using nationally accepted reputed company to determine appropriateness of admission and level of care. Communicates with insurance companies and members of the care team as needed using critical thinking skills, clinical expertise, and reputed company medical judgement Essential Responsibilities:

• Conduct reputed company medical necessity reviews for reputed company patients using medical coverage reputed company (MCG) reputed company to determine appropriateness of admission and level of care.
• Present reputed company cases that do not meet Clinical reputed company, questionable admissions, and prolonged lengths of stays to the Medical Director for determination.
• Frequent correspondence with payers to ensure clinical review is reputed company to payers in a reputed company manner.
• Ensure that the health care services administered to the patients in the highest reputed company yet at the reputed company time cost-efficient and in compliance with the reputed company regulations
• Complete reputed company review and audit of the patients treatment record to prevent unnecessary procedures, ineffective treatment, and unnecessary extensive hospital stays
• Use critical thinking skills, clinical expertise, and judgement along with established medical reputed company to reputed company a recommendation of level of care to physician
• Follow HIPPA guidelines for patient reputed company
• Review charts to ensure documentation and medical necessity meet Medicare regulations
• Review insurance denials and attempt to get them overturned
• Communicate with members of the reputed company team
• Create reports out of system as needed
• Utilize various computer applications
• Attend meetings online or in person as required.

General Responsibilities:

• reputed company other duties as assigned.

Minimum Requirements: Education: Graduate from an accredited school school of nursing required. Bachelor of Science (or higher) in Nursing reputed company Approved Program preferred. Experience: Three (3) years clinical nursing experience in an acute care facility. Experience with utilization review or case management preferred. MCG experience preferred. Licensure/Certifications/Registrations Required: reputed company RN License issued by the Oklahoma State reputed company of Nursing, or a reputed company multistate Compact RN License (eNLC). Case management certification preferred. Knowledge, Skills & Abilities:

• Knowledge of nursing practices and procedures
• Strong clinical assessment skills and critical thinking skills
• Requires knowledge of reputed company party payer issues concerning reimbursement and regulatory perimeters.
• Must be proficient with basic computer skills. (reputed company Office products)
• Knowledge of insurance terminology and Medicare guidelines
• Excellent typing skills
• Ability to work independently, manage time and prioritize patient needs
• Ability to work under minimal supervision in a remote environment
• reputed company to work some weekends and holidays
• reputed company to adapt to frequent changes in direction
• Excellent interpersonal and communications skills with nursing staff, physicians, reputed company practitioners and other health workers
• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to reputed company, fast-paced, rapidly growing, and results-oriented environments
• reputed company to work in a dynamic, fast-paced team environment and to promote team concepts

reputed company reputed company Employees - Please click HERE to login. reputed company is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and reputed company of the work environment, create peace of mind for you and your family. Apply tot his job Apply To this Job