Utilization Review Manager - Home Care jobs in Oregon

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 Manager - Utilization Review - Surgery Specialist
  • McKenzie-Willamette Medical Center
  • Springfield, OR FULL_TIME
  • Hourly Base Rate: $32.15 - $48.05
    Shift: Day Shift
    Hours Per Week: 40-hours
    Date Posted: 3/22/2024

    Job Summary:

    • Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
    • Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.
    • Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
    • Abstracts data from records and maintains

    Educational/Licensure:

    • Current Oregon RN license
    • Knowledge in areas such as InterQual Level of Care Criteria and Milliman & Robertson Criteria as well as knowledge of third party payer regulations related to utilization and quality review is also preferred.

    Qualifications:

    • Significant experience in the healthcare field is required including a minimum of five years as a clinical nurse in an acute care setting. In addition, having at least five to seven years of experience in case management, discharge planning, and/or utilization review is preferred.
    • Knowledge of regulatory and payer requirements for Case Management Activities.
    • Ability to critically evaluate and make decisions about whether discharge planning for highly difficult cases.

    Education

    Preferred
    • Bachelors or better in Nursing

    Licenses & Certifications

    Required
    • L-OR-RN License
  • 4 Days Ago

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Case Manager - Utilization Review - Surgery Specialist
  • McKenzie Willamette
  • Springfield, OR FULL_TIME
  • Hourly Base Rate: $32.15 - $48.05 Shift: Day Shift Hours Per Week: 40-hours Date Posted: 3/22/2024 Job Summary: Analyzes patient records to determine legitimacy of admission, treatment, and length of ...
  • 3 Days Ago

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Utilization Review RN *Remote
  • Providence
  • Beaverton, OR OTHER
  • DescriptionProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitmen...
  • 19 Days Ago

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Utilization Review Coordinator Lead
  • Umpqua Health
  • Roseburg, OR FULL_TIME
  • Company Description: Umpqua Health stands at the forefront of community health as a leading Coordinated Care Organization (CCO) committed to transforming healthcare delivery. Our mission is to enhance...
  • 13 Days Ago

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Registered Nurse / Utilization Review Exp
  • Cross Country Healthcare
  • Medford, OR FULL_TIME
  • Job DescriptionAs a registered nurse (RN), you will provide care for patients dealing with illness or injury. Depending on your role, you'll work at a hospital, outpatient center, private practice, ho...
  • 1 Month Ago

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Associate Utilization Review Specialist *Remote
  • Providence
  • Beaverton, OR OTHER
  • DescriptionProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitmen...
  • 1 Month 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

Oregon (/ˈɒrɪɡən/ (listen) ORR-ih-gən) is a state in the Pacific Northwest region on the West Coast of the United States. The Columbia River delineates much of Oregon's northern boundary with Washington, while the Snake River delineates much of its eastern boundary with Idaho. The parallel 42° north delineates the southern boundary with California and Nevada. Oregon is one of only four states of the continental United States to have a coastline on the Pacific Ocean. Oregon was inhabited by many indigenous tribes before Western traders, explorers, and settlers arrived. An autonomous government ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$76,449 to $97,468