Utilization Review Manager - Home Care jobs in Virginia

Introduction

Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Utilization Review Specialist - PRN with Dominion Hospital you can be a part of an organization that is devoted to giving back!

Benefits

Dominion Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the Dominion Hospital family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Utilization Review Specialist - PRN to help us reach our goals. Unlock your potential!

Job Summary and Qualifications

• Consistently demonstrates ability to integrate psychiatric case conceptualization framework into the Utilization Review.
• Organizes utilization management caseload, daily, based on daily census, number of telephone reviews, and complexity of individual case management processes.
• Utilizes and coordinates the multiple managed care companies pre-certification and continued certification processes and functions.
• Utilizes a case conceptual framework to assess and determine the viability of plan of care based on safety risk factors, community standards of practice, resource allocations and hospital policies and procedures.
• Integrates the UM process hospital wide through the coordination of communication processes with physician, treatment team, managed care case management communication processes with the physician, treatment team, managed care case management reviewer, and other staff members of the facility.
• Coordinates assists and provides information, as per hospital policies and procedures.
• Actively contributes as a team member to utilization of resources within the department.
• Maintains assigned patient caseload-evaluation for utilization management, documentation requirements, and provides information to managed care reviewers and hospital clinical staff.
• Thoroughly and accurately documents the rendering and results of the Utilization Review process for each third party payors in a timely manner based on UM service plan and guidelines and hospital wide policies and procedures.
• Documentation is easily understood and timely in nature, as observed by supervisor.

What qualifications you will need:

• Basic Cardiac Life Support must be obtained within 30 days of employment start date
• Nonviolent Crisis Intervention must be obtained within 30 days of employment start date
• Licensed Clinical Social Worker (LCSW), or Registered Nurse

Dominion Hospital has provided quality healthcare services for close to 50 years! Our 116-bed hospital is one of the region's leading mental healthcare facilities in Northern Virginia. Our convenient location in suburban Falls Church, VA, offers a full range of treatment options with a distinctive focus on crisis intervention and stabilization through our inpatient, partial hospitalization programs (PHP), and intensive outpatient (IOP). Our inpatient programs are comprised of five distinct units. These units include Child, Adolescent, Adult, Eating Disorders, and Complex Trauma and we maintain complementary PHPs and IOPs to match. We maintain an excellent outpatient referral network. Our patients receive the best quality care through specialized services in safe, healthy, confidential, and trauma-informed environments.

At Dominion Hospital, our care like family culture extends to our patients, our people, and our community. We are committed to each other. When we join together, our patients are cared for in the safest and most compassionate way.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

Be a part of an organization that invests in you! We are reviewing applications for our Utilization Review Specialist - PRN opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.