Utilization Review Manager - Home Care jobs in Missouri
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)
Recently Added Utilization Review Manager - Home Care jobs
Manager - Nursing Utilization Review (FT)
- MU Health Care
-
Columbia, MO
FULL_TIME
-
Join the MU Healthcare team as a dynamic leader overseeing the daily operations of our Utilization Management (UM) staff. You'll play a pivotal role in hiring, developing, and managing the UM team, utilizing your deep clinical knowledge and regulatory expertise to drive effective operations. As the lead, you'll facilitate the creation and improvement of system designs, ensuring optimal utilization and testing for our system. Collaborating closely with physicians, administrators, and interdisciplinary teams, you'll coordinate UM processes, analyze cases for physician referral, and provide technical guidance on complex cases. Step into a pivotal role at MU Healthcare, contributing to the optimization of patient care while becoming a valued part of Missouri's vibrant community.ABOUT MU HEALTH CARE:MU Health Care is a growing academic health system in mid-Missouri comprised of multiple hospitals - including the region’s only Level 1 Trauma Center and region’s only Children’s Hospital - and over 50 specialty clinics located throughout the region.As an MU Health Care employee, you’ll be part of an exceptional team committed to our mission of saving and improving lives. Our core values of inclusion, respect, service, discovery, responsibility and excellence foster a collaborative work environment where you can grow your career.Learn more about MU Health Care.Learn more about living in Columbia, MO.EMPLOYEE BENEFITS:
- Health, vision and dental insurance coverage starting day one.
- Generous paid leave and paid time off, including nine holidays.
- Multiple retirement options, including 100% matching up to 8% and full vesting in three years.
- Tuition assistance for employees (75%) and immediate family members (50%).
- Discounts on cell phone plans, rental cars, gyms, hotels and more.
- See a comprehensive list of benefits here.
Apply Here: https://uofmo.taleo.net/careersection/muhc/jobdetail.ftl?job=23001674&lang=en
Shift: Monday - Friday, 8-5.Work Location: Quarterdeck - Columbia, MO.
Salary Range: $78,520 - $127,962/year - final salary based on experience.
JOB DUTIES:- Supervise the daily operations and production of the UM staff and ensure appropriate usage of resources in order to facilitate the UM process.
- Act as lead to create system design creation, improvements, optimum utilization and associated testing for our Allscripts (ECIN) system.
- Oversee activities of subordinates by assigning workload, reviewing retrospectively utilization review records prepared for admissions and continued stay reviews, reviewing cases referred to the physician advisor, and providing technical guidance on unusual cases.
- Analyze cases for referral to the physician advisor to ensure that the admission or continued stay is being questioned based upon appropriate screening criteria and standards; serves as the liaison with the physician advisor for the referral of unusual questionable cases, on referred cases for reconsideration, and to obtain authorization for the issuance of denial letters.
- Confer with physicians, administrative personnel, and other disciplines in the hospital to coordinate the work of the unit, obtain information, answer questions concerning the necessity for utilization review, and develop review procedures.
- Determine need for and conducts in-service training to improve quality of admission and continued stay reviews, and to disseminate information concerning new or revised procedures.
- Develop procedures for the compilation of information from medical charts concerning particular diagnoses, problems, procedures, or practitioner categories as directed for medical care evaluation studies.
- May attend Utilization Review Committee meetings to inform the committee of new or revised utilization review requirements, the impact of the requirements, and procedures to be implemented for compliance.
- Perform, monitor and manage root cause analysis of authorization denials to ensure improvement and optimum reimbursement.
- Works closely with other leaders within the Revenue Cycle to impact overall performance improvement.
- Plan, develop, and implements procedures to fulfill the requirements and guidelines for an effective and timely utilization review system.
- Responsible for planning, development, and implementation of procedures for admission and continued stay reviews, in accordance with the Professional Standards Review Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard.
- Review, retrospectively, utilization review records for completeness, use of appropriate codes, correctness of primary reason for admission and certified hospital days, and inclusion of all relevant supporting medical information.
- Work with Professional Standards Review Organization representative to orient new staff to Federal laws and regulations pertaining to Medicare and Tri-Care reimbursement.
- Manage the development, coordination, and maintenance of daily staffing schedules to ensure the appropriate level of coverage and continuity of care.
- Monitor and oversee time and attendance in alignment with MU Health Care policies and practices, ensuring accuracy of records and timely approval for payroll purposes.
- May complete unit/department specific duties and expectations as outlined in department documents.
Knowledge, Skills, & Abilities:- Computer literacy.
- Ability to interact with others using discretion, resourcefulness and persuasiveness while maintaining a professional attitude.
Required Qualifications:- Bachelor of Science in Nursing or a related degree, or an equivalent combination of education and experience from which comparable knowledge, skills and abilities can be acquired.
- Three (3) years of RN experience.
- Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.
Preferred Qualifications:- One (1) year of experience in the treatment of chronic and short-term medical and surgical inpatient problems.
- One (1) year of experience in nursing supervision or one (1) year of experience in nursing clinical instruction.
- Additional license/certification requirements as determined by the hiring department.
Physical Demands:- The physical demands described here are representative of those that must be met with or without reasonable accommodation.
- The performance of these physical demands is an essential function of the job.
- The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees.
- The employee may be required to move objects up to 10 lbs.
We value the uniqueness of every individual and strive to ensure each person’s success. Contributions from individuals with diverse backgrounds, experiences and perspectives promote intellectual pluralism and enable us to achieve the excellence that we seek in learning, research and engagement. This commitment makes our university a better place to work, learn and innovate. - 19 Days Ago
Manager of Utilization Review
- Children's Mercy Hospital
-
Kansas, MO
FULL_TIME
- Manager of Utilization Review Requisition ID 2024-28936 Requisition Post Information* : Posted Date 3 hours ago(3/7/2024 9:09 AM) Posting Category Nursing Division CARE MANAGEMENT Work Type Full Time ...
- 17 Days Ago
Manager of Utilization Review
- Children's Mercy KC
-
Kansas, MO
OTHER
- Thanks for your interest in Children's Mercy! Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s Mercy, we believe in making a difference in the lives of...
- 1 Month Ago
Utilization Review Coordinator - KCRO
- State of Missouri
-
Kansas City, MO
FULL_TIME
- Utilization Review Coordinator KCRO (Developmental Disability Service Specialist) Salary: $1,906.33 Semi-Monthly ($45,751.92 Annually) **Typical working hours: 8:00 AM to 5:00 PM, Monday through Frida...
- 13 Days Ago
Utilization Review Nurse
- Actalent
-
Kansas, MO
OTHER
- Actively looking to hire multiple RNs to join a growing managed care organization on a Sunday to Thursday OR Tuesday to Saturday basis doing utilization review for PAC patients. This role is looking f...
- 3 Days Ago
Utilization Review Specialist (remote)
- Coronis Health
-
Fenton, MO
FULL_TIME
- Utilization Review Specialist/Behavioral Health Substance AbuseFLSA Status: Exempt Classification: Full-Time Reports To: The UR Specialist will report to UR Manager. Job Overview: The Utilization Revi...
- 16 Days Ago
Utilization Review Manager - Home Care jobs at Popular Companies
Utilization Management Manager
- Medasource
-
Fresno, CA
- Job Title: Utilization Management Manager Location: Fresno, California (travel reimbursement if needed) Start Date: ASAP...
- 4/16/2024 12:00:00 AM
Utility Management Director
- Hunt
-
Honolulu, HI
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Utilization Management Specialist - RN
- Sanford Health
-
Sioux Falls, SD
- Create Your Career With Us! Sanford Health is one of the largest and fastest-growing not-for-profit health systems in th...
- 4/16/2024 12:00:00 AM
Utilization Manager - Remote
- Gentiva
-
Mooresville, NC
- Our Company: Gentiva is an industry leader in hospice, palliative, home health, and personal home care. Our place is by ...
- 4/15/2024 12:00:00 AM
Utility Manager
- DSJ Global
-
St Louis, MO
- We are seeking a highly skilled and experienced Utility Manager to oversee the operation and maintenance of utility syst...
- 4/14/2024 12:00:00 AM
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...
- 4/12/2024 12:00:00 AM
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 ...
- 4/12/2024 12:00:00 AM
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...
- 4/12/2024 12:00:00 AM
About Missouri
Missouri is landlocked and borders eight different states as does its neighbor, Tennessee. No state in the U.S. touches more than eight. Missouri is bounded by Iowa on the north; by Illinois, Kentucky, and Tennessee across the Mississippi River on the east; on the south by Arkansas; and by Oklahoma, Kansas, and Nebraska (the last across the Missouri River) on the west. Whereas the northern and southern boundaries are straight lines, the Missouri Bootheel protrudes southerly into Arkansas. The two largest rivers are the Mississippi (which defines the eastern boundary of the state) and the Misso...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$72,677 to $92,656