Loan Review Manager jobs in Mishawaka, IN

• Complete medical necessity review of charts.

• Communicate with insurance companies when indicated to provide clinical reviews to obtain authorization for hospital stays.

• Refer cases not meeting InterQual/Milliman criteria to Physician Advisor for evaluation and follow through with recommendations.

• Consult with the physician whenever admission or continued stay does not meet approved criteria and cannot justify the admission or continuation of hospitalization.

• Monitor and complete cases as identified on initial, concurrent and discharged review work queue.

• Monitor and complete cases on the Stop Bill, Auth Cert Pending Discharged work queues, as well as others as identified by supervisor.

• Actively communicate with and assist Case Managers

• Support compliance with HFAP, State, and Federal Agencies for assigned areas.

• Keep abreast of current trends in Utilization Review and Managed Care processes.

• Maintain current knowledge of Medicare, Medicaid, and third party payor rules.

• Maintain accurate, concise, and timely documentation in Epic.

• Associate degree in nursing/patient care required

• Bachelor's Degree in nursing/patient care preferred

• Registered Nurse (RN - Indiana licensure) required

• 3 years of nursing/patient care experience required

• 2 years of Utilization or Case Management experience preferred

**Please note that this a part time position. The schedule is as follows: every Wednesday evening from 2pm-12pm CDT and every other Saturday and Sunday from 7am - 5pm CDT.

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.