Utilization Review Manager - Home Care jobs in Kentucky

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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Case Management Specialist - Utilization Review
  • Utilization Review in Owensboro, KY - Owensboro
  • Owensboro, KY FULL_TIME
  • Summary

    Job Summary

    Facilitates cost-effective, quality patient outcomes by determining the appropriate level of care and providing guidance, education, and support to assigned patients.
     
    Job Responsibilities
    • Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
    • Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
    • Provides appropriate clinical information to payers as requested within specified time frame.
    • Collaborates with the Physician, Medical Director, Director, Manager, and Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization.
    • Delivers regulatory letters to patients as needed.
    • Provides education and acts as a resource for physicians, staff, and patients/families regarding utilization review processes.
    • Trains new case managers, students, and interns as needed.
    Qualifications
    • Associate's degree or higher in Nursing required upon hire AND
    • Bachelor's degree or higher in Nursing required within 5 years of employment in this position
    • No experience required
    • RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire
    Skills and Attributes
    • Requires critical thinking skills and decisive judgment.
    • Works under minimal supervision.
    • Must be able to work in a stressful environment and take appropriate action.
    Physical Demands
    • Standing: Occasionally
    • Walking: Occasionally
    • Sitting: Frequently
    • Lifting 0-25 lbs: Rarely
    • Lifting 25-75 lbs: Never
    • Lifting over 75 lbs: Never
    • Carrying 0-25 lbs: Rarely
    • Carrying 25-75 lbs: Never
    • Carrying over 75 lbs: Never
    • Pushing/Pulling 0-25 lbs: Rarely
    • Pushing/Pulling 25-75 lbs: Never
    • Pushing/Pulling over 75 lbs: Never
    • Climbing: Rarely
    • Bending/Stooping: Rarely
    • Kneeling: Rarely
    • Crouching/Crawling: Rarely
    • Reaching: Occasionally
    • Talking: Frequently
    • Hearing: Occasionally
    • Repetitive Foot/Leg Movements: Never
    • Repetitive Hand/Arm Movements: Frequently
    • Keyboard Data Entry: Frequently
    • Running: Never
    • Vision: Depth Perception: Frequently
    • Vision: Distinguish Color: Frequently
    • Vision: Seeing Far: Frequently
    • Vision: Seeing Near: Frequently
    Owensboro Health Core Commitments

    INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.

    RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.

    TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.

    INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.

    SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.

    EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.
  • 8 Days Ago

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Utilization Review Clinician
  • Addiction Recovery Care
  • Louisa, KY FULL_TIME
  • About Addiction Recovery CareAt Addiction Recovery Care we incorporate the best practices of clinical drug addiction treatment. We provide addiction recovery that works with a commitment to provide ho...
  • 14 Days Ago

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Utilization Review RN - Home Health (Remote)
  • Adoration Home Health and Hospice
  • LOUISVILLE, KY FULL_TIME
  • Our Company Adoration Home Health and Hospice Overview Adoration Home Health is currently seeking a Utilization Review RN - Registered Nurse to support our home health operations throughout multiple r...
  • 16 Days Ago

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Utilization Review Case Coordinator
  • UHS
  • LEXINGTON, KY FULL_TIME
  • Responsibilities Utilization Review Case Coordinator Opportunity:Full Time, Day Shift The Case Coordinator is responsible for managing and coordinating the treatment activities offered to the patient,...
  • 23 Days Ago

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Utilization Review Supervisor
  • BrightSpring Health Services
  • Louisville, KY FULL_TIME
  • Our Company: BrightSpring Health Services Overview: The Home Health Utilization Review Supervisor will manage and conduct Utilization Review activities to include, but not limited to, ICD-10 coding an...
  • 10 Days Ago

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Utilization Review Coordinator
  • Ramey-Estep / Re-group
  • Rush, KY FULL_TIME
  • Function:The Utilization Review Coordinator (URC) has the primary responsibility of monitoring adherence to the agency’s utilization review procedures and ensuring appropriate leveling of client needs...
  • 10 Days Ago

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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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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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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

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Utilization Management Coordinator
  • Hackensack Meridian Health
  • Oakhurst, 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

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Utilization Management Coordinator
  • Hackensack Meridian Health
  • Neptune, 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

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Utilization Management Coordinator
  • Yoh, A Day & Zimmermann Company
  • Alameda, CA
  • Job Description Job Description Utilization Management Coordinator needed for a remote contract opportunity with Yoh’s c...
  • 3/25/2024 12:00:00 AM

Kentucky (/kənˈtʌki/ (listen) kən-TUK-ee), officially the Commonwealth of Kentucky, is a state located in the east south-central region of the United States. Although styled as the "State of Kentucky" in the law creating it, (because in Kentucky's first constitution, the name state was used) Kentucky is one of four U.S. states constituted as a commonwealth (the others being Virginia, Pennsylvania, and Massachusetts). Originally a part of Virginia, in 1792 Kentucky became the 15th state to join the Union. Kentucky is the 37th most extensive and the 26th most populous of the 50 United States. Ke...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$71,552 to $91,224