Utilization Review Manager - Home Care jobs in North Carolina

At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care."

Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022 & 2023! Come be a part of our dynamic team; you'll join Ashe's 2022 & 2023 Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice!  This is your opportunity to make a large difference in a small community!

Hours & Days Vary - PRN (as needed) weekends & holidays required | No Supervisory Responsibilities | No Travel | Pay commensurate with experience.

JOB SUMMARY: Utilization Review/Patient Care Coordinator (UR/PCC) is responsible for the coordination and management of the Ashe Memorial Transitional Care Services program, also known as Swing Bed.  This includes managing the referral process, both internal and external, as well as marketing and outreach to other facilities.  The UR/PCC is also responsible for all Utilization Review activities within Ashe Memorial Hospital.  This individual will be responsible to ensure that both the TCS program and Utilization Review meets all regulatory compliance from accrediting agencies.  Performs all work with accordance to the mission, vision and values of Ashe Memorial Hospital (AMH).

Minimum Job Qualifications:

Certifications/Education:

• BLS certification.
• Registered Nurse in North Carolina.

Experience:

• Swing bed coordination experience preferred.
• Utilization review experience preferred.

ESSENTIAL FUNCTIONS:

1. Coordinates the Transitional Care Services (Swing bed) program and works with the physician and other hospital staff to determine when a patient is appropriate admission to the program.
2. Prepares and reviews Transitional Care Services (TCS) documents for accuracy and regulatory compliance.
3. Acts as a liaison, engages directly with hospital managers, providers and surrounding hospitals to develop relationships, initiate referrals, maintain and provide follow-up on all referral leads, marketing and promotional strategies that meet program goals and objectives.
4. Schedules and attends TCS interdisciplinary meetings regarding treatment of care and progress for each TCS patient.
5. Coordinates efforts to meet the personal needs of TCS patients.
6. Ensures TCS program meets all of the Swing Bed regulatory requirements.
7. Maintains information for current and any ongoing performance improvement plan initiatives.
8. Works with social work and discharge planning to ensure TCS patients have appropriate and safe discharge plan.
9. Monitors inpatient Utilization Review activities to decrease length of stay.
10. Responsible for preauthorization process of outpatient testing, including follow-up on received denials.
11. Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of all hospital admissions.
12. Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient’s medical records.
13. Coordinates with social work and discharge planning to facilitate timely discharge.
14. Works within NC RN scope of practice at all times.
15. Demonstrates excellent customer service skills.
16. Maintains a good working relationship with department coworkers, other departments, physician offices and external agencies.
17. Displays a positive attitude toward work. Contributes positively to hospital morale.  Demonstrates a teamwork attitude with all staff.
18. Performs other duties as assigned.
19. Completes annual employment requirements such as annual employee health and Health and Safety Inservice commonly referred to as ADI.
20. Adheres to the attendance policy.
21. Uses computerized punch system correctly to accurately record working hours.
22. Adheres to the AMH Customer Service Standards. Supports the mission and vision of AMH.  Builds and maintains customer satisfaction.  Shows interest in, anticipates, and responds timely to customer needs.
23. Communicates effectively with others, works together as a team.
24. Maintains confidentiality.
25. Supports the hospital and promotes a positive attitude.
26. Adheres to dress code, appearance is neat and clean.
27. Wears identification while on duty.
28. Adheres to the HIPPA and Privacy policies and procedures. Reports any violation or appearance of violation of the policies and procedures and/or laws and regulations addressed in the Compliance Plan and the hospital Code of Conduct to the Compliance Officer, to a member of Senior Leadership or to the Department Director.
29. Adheres to the AMH customer service standards. Builds and maintains customer satisfaction.  Shows interest in customer needs and anticipates and responds to them in a timely manner.

Must be willing to receive all required vaccinations (i.e., flu shot, etc.). All new employees working must be fully vaccinated as a condition of employment (unless the new hire has requested and received an exemption). Candidates for employment will be notified of this policy requirement prior to the start of employment. After receiving an offer of employment, new employees must provide proof of vaccination or request and receive an exemption before beginning work.

To apply, please fill out an application, attach a cover letter, and resume. Include gaps in employment and reasons for separation.

Criminal background check and pre-employment drug screen required upon conditional job offer.

***Benefits apply the 1st of the month following employment, per policy.***

*For full job description and benefits, please contact Human Resources.

Ashe Memorial Hospital is an equal opportunity employer and, as such, considers individuals for employment according to their abilities and performance.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.  Employment decisions are made without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, genetic information, or any other classification protected by law. All employment requirements mandated by local, state, and federal regulations will be observed.