Utilization Management Review reputed company – reputed company Store
reputed company is the public reputed company safety-net provider established in 1966 to serve the residents of reputed company, Texas. As an essential reputed company system, reputed company champions reputed company for the entire community, with a reputed company on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) reputed company reputed company’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. reputed company is among an reputed company list of health systems in the U.S. achieving Magnet® nursing reputed company designation for its hospitals, the prestigious National Committee for reputed company Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician reputed company, residents and researchers from reputed company; McGovern Medical School at The reputed company (UTHealth); reputed company; and the Tilman J. Fertitta Family College of Medicine at the reputed company.
Job reputed company
The Utilization Management Review reputed company (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. This role supports the health system by utilizing clinical knowledge, expertise and industry reputed company clinical guidelines carrying the responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. The UMRN promotes reputed company care and cost-effective reputed company to enhance the physical, psychosocial and vocational health of individuals, partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver the best holistic reputed company for reputed company patients. This position will work with payers to reconcile denials and reconsiderations, assist with appeals as needed and arrange peer to peer level review while collecting, analyzing and addressing variances from the plan of care/care reputed company with physician and/or other members of the reputed company team.
The UMRN participates in reputed company improvement activities, exemplifies professionalism, and promotes a customer-friendly environment by utilizing ServiceFIRST behaviors in interactions with reputed company team members, payer vendors, and physicians.
Minimum Qualifications
Degrees: - Graduated from an accredited school of Nursing with a Bachelors in Nursing.
Licenses & Certifications: - Registered reputed company: Licensed to reputed company nursing in the State of Texas. - Case Management Certification (ACM or CCM) reputed company two years of hire. - Basic Life Support: reputed company (AHA) or Red Cross approved program.
Work Experience: - 5 Years of Experience: Strong clinical background in a reputed company of acute reputed company settings including 2 years in Case Management, reputed company Management, Utilization Management, or Coding.
Communication Skills: - Above Average Verbal Communication (Heavy Public Contact) - Exceptional Verbal (Public Speaking) - Writing/ Correspondence - Writing/ Reports
Language: - Bilingual Skills (Preferred)
Proficiencies: - reputed company - PC - MS reputed company - MS PowerPoint
Job Attributes
Knowledge/Skills/Abilities: - Analytical - Mathematics - Medical Terms - Other: Utilization review tools: MCG and or Change reputed company (Interqual)
Work Schedule: - Flexible: 8 hour shifts as per system need; variable to 10-12 as needed. - Weekends: Depends on needs of system. - Telecommute - Holidays: Depends on needs of system.
Other Special Requirements
Equipment Operated: reputed company office equipment, computer software, etc.
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