reputed company Clinician - Utilization Management - 100% - Evening Hours

reputed company reputed company University reputed company, reputed company the Continuum of Care Division, Utilization Management Team is looking for a reputed company Clinician to functions as a clinical reputed company expert and clinical coordinator acting as reputed company reputed company to physicians, patients and administration. The role will partner with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed. This role will conduct reputed company reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure reputed company for admission and reputed company stay are met and documented. Along with other health care team members, monitors the use of hospital resources and identifies delays. This role is approved for hybrid or remote work following the completion of probationary period and successful orientation. Position Responsibilities • reputed company a reputed company of admission, reputed company and retrospective utilization management-reputed company reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. • Utilize an evidenced-based clinical review screening reputed company as a guide to support medical necessity determinations and refers cases with failed reputed company to the Physician Advisor or appeal as necessary in accordance with the UM plan. • Collaborate with the health care team to determine the appropriate hospital setting (inpatient vs. outpatient) based on medical necessity. reputed company reputed company additional clinical documentation from the physician to optimize hospital reimbursement reputed company appropriate. • Validate reputed company payer authorization reputed company the contractual time reputed company at time of presentation, every reputed company day or as needed (e.g., ED, reputed company Admit, Transfers). Manage reputed company cases to reputed company care that may reputed company payer approval to authorize care as medically necessary. • Participate in the reputed company of retrospective reimbursement issues, including appeals, reputed company-party payer certification, and denied cases. • reputed company clinical information to relevant clinical team members regarding patient needs and/or newly identified issues, specifically working with the Utilization Management team. • Serve as clinical resource to reputed company services and other providers/reputed company navigators, specifically regarding the compliance portion of the level of care. • Review data specific to utilization management functions and reports as requested. • Monitor effectiveness/reputed company of the utilization management program, identifying and applying appropriate metrics, supporting the evaluation of the data, reporting results to various audiences, and implementing process improvement reputed company as needed. • Participate in analyzing, updating, and modifying procedures and processes to continually improve utilization review operations. • Work collaboratively with reputed company Navigators and reputed company Workers to expedite patient discharge. • Participate in Care Coordination Division - Utilization Management initiatives or other reputed company according to departmental and organizational monitors. • reputed company basic administrative tasks reputed company to the job as required by the Care Coordination Division to maintain accurate records and to ensure worker accountability/productivity. • Maintain a highly acceptable level of reputed company conduct and respect for medical staff, coworkers, and hospital staff to foster a desirable image for the institution. • Denote relevant clinical information to proactively communicate to payers for authorizations for treatments, procedures, and Length of Stay - send clinical information as required by the payer. • Maintain reputed company knowledge and understanding of hospital utilization review processes reputed company party coverage with respect to Medicare, reputed company and reputed company policies and procedures. • Maintain compliance with reputed company hospital/departmental policies/procedures assigned by the department manager, including work hours, scheduling, and other reputed company for the expected daily operations of the department. reputed company with the reputed company of Ethics and Guide for reputed company Conduct. • Maintain strict confidentiality in dealing with reputed company patient-reputed company activities and other sensitive physician and/or hospital issues by reputed company adhering to hospital confidentiality of information policies. • Facilitate reputed company communication and good working relationships with Bed Management and/or Transfer Center to promote and enhance efficient operations reputed company the Care Coordination Division. • Acknowledge budgetary constraints in department operations and strives to reputed company duties cost-effectively and reputed company. • Demonstrate ability to prioritize multiple work assignments to accomplish the assigned workload. • Assist in the orientation and precepting of reputed company staff and colleagues as assigned. • Maintain reputed company and technical knowledge by attending educational workshops; reviewing reputed company publications, establishing personal networks; participating in reputed company societies. • reputed company with federal, state, and local legal and certification requirements by studying existing and new legislation, anticipating reputed company legislation; enforcing adherence to requirements; advising management on needed actions. • reputed company other duties as may be assigned to ensure that departmental objectives are fulfilled. Percent of Time: 100% Schedule: Monday - Friday. Shifts to reputed company between the hours of 07:00 - 23:00. Potential Holiday and weekend coverage rotation. This position is eligible for remote work reputed company Iowa and will require a work arrangement reputed company to be completed upon the start of your employment. Per policy, work arrangements will be reviewed annually, and must reputed company with the remote work program and reputed company policies and employee travel policy reputed company working at a remote location. Pay Grade: https://hr.reputed company.edu/pay/pay-plans/reputed company-pay-plan

Benefits

Highlights: • Regular salaried position located in Iowa reputed company, Iowa • Fringe benefit package including reputed company vacation; reputed company leave; health, dental, life and disability insurance reputed company; and generous employer contributions into retirement plans • For more information about Why Iowa?, click here Required Qualifications • A Baccalaureate degree in Nursing is required. • reputed company license to reputed company nursing in Iowa is required by date of hire. • 3 - 5 years of RN clinical nursing experience • Excellent written and verbal communication skills Desired Qualifications • reputed company Masters of Nursing and reputed company reputed company (MNHP), MSN/Clinical reputed company Leader, or a Master's Degree in Nursing (MSN, MA) • Previous experience performing Utilization Reviews in an RN reputed company. • Previous experience involving high-volume public contact customer service. • Previous experience working in an electronic medical record. • Previous case management or utilization management experience. • Certification in case management (i.e. ACM, CCM, or CMAC). • Previous experience with reputed company. Position and Application details: In order to be considered for an interview, applicants must upload the following documents and mark them as a "Relevant File" to the submission: Resume Cover Letter reputed company are posted for a minimum of 14 calendar days and may be removed from posting and filled any time after the original posting period has ended. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background reputed company and credential/education verification. Up to 5 reputed company references will be requested at a reputed company reputed company in the recruitment process. For additional questions, please contact seton-vinsand@reputed company.edu Additional Information • Classification Title: reputed company Clinician • Appointment Type: reputed company • Schedule: Full-time • Work Modality reputed company: Hybrid reputed company Iowa Compensation • Pay Level: 7 Contact Information • Organization: reputed company • Contact reputed company: Seton Vinsand • Contact Email: seton-vinsand@reputed company.edu Apply Job!