Utilization Review Manager - Home Care jobs in District of Columbia

Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Utilization Review Specialist
  • Department of Behavioral Healt
  • Washington, DC FULL_TIME
  • The incumbent functions as a Utilization Review Specialist in Health Information Management. The Utilization Review Specialist performs studies/reviews of medical records to monitor and to determine that the quality of clients’ treatment and care are maintained at the highest level. Examines and evaluates various components of client’s medical records to bill for Medicare reimbursement and commercial insurance for about 92 to 105 clients with insurance. These numbers may vary from month to month. When assessing the documentation, adheres to the policies and various guidelines, set by internal and external bodies, such CMS and JACHO. Attends treatment plan meetings, when necessary, in order to get collateral information from family members and case managers, to forward to commercial insurance companies. The incumbent is responsible for providing feedback to Utilization Review Committees, clinicians, clinical staff of various disciplines and Directors concerning the development and refinement of quality care criteria. Provides individual case discussions with attending clinicians and multidiscipline staff members to attain clarifications, to render recommendations, to tactfully persuade and negotiate oppositions and to facilitate acceptance of recommendations and modifications. Identifies problems, trends, and deficiencies, and factors requiring examination, evaluation and/or resolution as a result of reviewing various clinical documentations, data, methods and procedures related to admissions, continued hospitalization, treatment and care. Collects information and statistical data for compiling monthly reports which identify trends, problems, recommendations, achievements, resolutions and areas of high and low compliance. Submits annual written reports, consisting of statistical and graphic data, complied from the variety of studies performed in each division during the year. Distributes Level of Care Survey Forms each month to designated clinical staff member for completion and is responsible for attaining necessary corrections on forms returned with errors. Serves as liaison and resource person responsible for establishing and maintaining effective interactive communication and cooperation between the clinicians, multi-discipline clinical staff members and divisions’ Utilization Review Committees/Quality Assessment Committees. Adapts studies to stay in line with changing criteria and formats. Responsible for making recommendations, which have SEH-wide affect to clinicians, clinical staff of various disciplines and division directors regarding criteria compliance issues. Prioritizes reviews to ensure that wards are visited during convenient and appropriate times.

    RESIDENCY PREFERENCE AMENDMENT ACT OF 1988

    A person applying for a position in the Career Service, Educational Service, Management Supervisory Service, a line attorney position in the Legal Service (series 905), or an attorney position in the Excepted Service (series 905) who is a bona fide District resident AT THE TIME OF APPLICATION for the position may be awarded a 10-point residency preference over non-District applicants, unless the person declines the preference points. If selected, the person shall be required to present no less than 8 proofs of bona fide District residency and maintain such residency for 7 consecutive years from the effective date of the appointment. Failure to maintain bona fide District residency for the 7-year period will result in forfeiture of employment.

    This position IS in a collective bargaining unit and you may be required to pay an agency service fee through an automatic payroll deduction

    Position Designation: This position is deemed as “Security Sensitive” pursuant to Section 410 of Chapter 4 of the D.C. Personnel Regulations, in addition to the general suitability screening, individuals applying for or occupying security sensitive positions are subject to the following checks and tests:

    • Criminal background check;
    • Traffic record check (as applicable);
    • Consumer credit check (as applicable);
    • Reasonable suspicion drug and alcohol test; and
    • Post-accident or incident drug and alcohol test.

    Area of Consideration: Open to the Public

    Duration of Appointment: Permanent

    First Screening: April 8, 2024.

    Tour of Duty: 8:30 a.m. - 5:00 p.m. Monday to Friday

    Work Experience

    Advanced knowledge of mental health concepts, principles, practices, programs and operations based on professional training in health care methodologies. Detailed knowledge of techniques for record review methods, evaluation of clinical documentation and clinical interventions in the medical records review. Ability to work in a team environment and assist others such as third parties in understanding documentation requirements

    Qualifications

    In addition to meeting the basic requirements, this position requires one (1) year of experience equivalent to the next lower grade level equivalent to DS-11.

    Education

    Candidates must have completed four (4) years course of study in an accredited college or university. Bachelors or higher degree with major study in an academic field related to health or allied sciences pertinent to this position.

    Selective Placement Factor:

    Bachelor’s Degree in Nursing preferred.

    Work Environment

    Work is performed in a controlled environment and involves some exposure to moderate risk of accidents and requires following basic safety precautions. THIS POSITION REQUIRES A PRE EMPLOYMENT PHYSICAL, CONSUMER CREDIT CHECK & DRUG TEST.

    COVID-19 Vaccination

    The Government of the District of Columbia values the safety of our employees, our residents, and our visitors. In support of these values, if you are selected for this job you must be fully vaccinated against COVID-19, except when vaccination is not medically advised or violates your sincerely held religious beliefs in violation of EEO laws. If you are invited to join our team you must submit proof that you are fully vaccinated against COVID-19 to your initial HR representative, or you must request an exemption from your representative. New employees must either provide proof of vaccination or be granted a medical or religious exemption before working with the Government of the District of Columbia.

    EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.

    Job Offers: Official Job Offers are made by the office of Human Resources Only.

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Utilization Review Nurse
  • medstar
  • Washington, DC FULL_TIME
  • Under the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate comp...
  • 1 Month Ago

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Home Care Registered Nurse (RN) Manager - DC
  • Ingleside at Home
  • Washington, DC FULL_TIME
  • We are currently seeking a full time Nurse Manager to join our team for our DC location. This position will primarily be responsible for the client assessments and oversight of the clinical staff; thi...
  • 19 Days Ago

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Data Processing Review Manager
  • Serco North America
  • Washington, DC FULL_TIME
  • Position Description Serco is seeking a motivated Data Processing Review Manager to join our talented and fast-paced Public Sector Solutions team in supporting CMS’ implementation of the Payment Error...
  • 5 Days Ago

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Eligibility Review Manager
  • Serco North America
  • Washington, DC FULL_TIME
  • Position Description Serco is seeking a motivated Eligibility Review Manager to join our talented and fast-paced Public Sector Solutions team in supporting CMS’ implementation of the Payment Error Rat...
  • 10 Days Ago

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RN Case Manager/Utilization Management
  • Networks Connect Professional Staffing
  • Washington, DC FULL_TIME
  • Networks Connect Professional Staffing is conducting a search on behalf of our client for an RN Case Manager. Responsibilities: Conduct timely clinical reviews drawing upon appropriate resources and a...
  • Just Posted

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Director Utilization Management
  • AMI Network
  • San Diego, CA
  • I’m partnered with a major health plan in San Diego to find a Director of Utilization Management! This top-rated Medicai...
  • 3/28/2024 12:00:00 AM

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Utilities Manager
  • City of Upland, CA
  • Upland, CA
  • Salary : $124,287.53 - $158,625.88 Annually Location : Public Works - 1370 N. Benson Ave Upland, CA Job Type: Full Time ...
  • 3/28/2024 12:00:00 AM

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Utilities Manager (At-Will)
  • City of Rialto, CA
  • Rialto, CA
  • Salary : $116,448.00 - $156,060.00 Annually Location : Rialto, CA Job Type: Full-Time Job Number: 23-072 Department: RUA...
  • 3/28/2024 12:00:00 AM

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Maintenance and Utilities Manager
  • The Judge Group
  • Somerset, NJ
  • Do you love candy and snacks? Are you looking to join an ever evolving and rapidly growing team? PIM Brands might just b...
  • 3/28/2024 12:00:00 AM

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Utilization Management Assistant
  • Trinity Health
  • Des Moines, IA
  • Employment Type: Full timeShift: Description: GENERAL SUMMARY: Under general supervision, the Utilization Management Ass...
  • 3/28/2024 12:00:00 AM

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Utility Manager
  • Prairie Band Potawatomi Nation
  • Mayetta, KS
  • Tier: 2 Department: Administration Supervisor: General Manager of Operations Location: 16281 Q Road, Mayetta KS 66509 Pa...
  • 3/25/2024 12:00:00 AM

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Utility Management Consultant
  • HDR, Inc.
  • Charlotte, NC
  • Qualifications and Experience * BS in Civil or Environmental Engineering or a related technical discipline required. * M...
  • 3/25/2024 12:00:00 AM

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Utilization Management Coordinator
  • Hackensack Meridian Health
  • Point Pleasant Beach, NJ
  • Description: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients ...
  • 3/25/2024 12:00:00 AM

Washington, D.C. is located in the mid-Atlantic region of the U.S. East Coast. Due to the District of Columbia retrocession, the city has a total area of 68.34 square miles (177.0 km2), of which 61.05 square miles (158.1 km2) is land and 7.29 square miles (18.9 km2) (10.67%) is water. The District is bordered by Montgomery County, Maryland to the northwest; Prince George's County, Maryland to the east; Arlington County, Virginia to the south; and Alexandria, Virginia to the west. The south bank of the Potomac River forms the District's border with Virginia and has two major tributaries: the An...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$84,646 to $107,918