Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Utilization Management Specialist (Registered Nurse Lead) Case Management Mount Carmel St. Ann's Full Time

Expired Job

Mount Carmel Health System Westerville , OH 43082

Posted 4 months ago

Department:

OH110_62500_000 Social Services Mcsa

Expected Weekly Hours:
40

Shift:

Position Purpose:

At Mount Carmel, we're committed to making a meaningful difference in the lives of our patients and communities. Our colleagues people like you share our passion for always going above and beyond to provide the highest standards of care.

Job Description Details:

Our professional nurses are truly the heart and soul of Mount Carmel. It is their resilience, humility and determination that drive positive patient outcomes.

To support you, Mount Carmel provides continuous opportunities for personal balance, professional opportunity and clinical growth. Our culture of shared governance and collaboration creates an environment that puts the focus on what's truly important our patients and the communities we serve.

Utilization Management Specialist will provide education and acts as a resource to the UR Case Management staff for selection of the correct criteria set to determine the appropriate Level of Care (LOC) for either an admitted patient and/or for those patients who do not meet inpatient LOC criteria but their care is required for observation as an outpatient until a determination of admission or discharge can be made. The UM Specialist serves as the point of contact for their respective MCHS hospital for all RAC activity and UR functions.

Responsibilities

  • Participates in new associate orientation and training. Maintains RAC database and provides monthly RAC and denial updates to the department. manager, finance department and organizational integrity. Makes recommendations with the support of the department manager and the physician advisor whether to appeal or close RAC denial cases.

  • Collaborates with revenue integrity, compliance, billing and coding to ensure that cases are coded and billed appropriately in accordance with federal rules and regulations.

  • Works in collaboration with the secondary level review and physician advisors on cases to ensure correct level of care assignments. Monitors high dollar observation cases daily and follows up on observation cases daily with the UR case manager

Requirements/Qualifications

  • Graduate from school of nursing with current license to practice in the State of Ohio; baccalaureate required.

  • Licensure / Certification: Nursing License through the State of Ohio

  • Minimum of five years' experience in Utilization Review and proven experience in effectively monitoring associate performance and coaching to improve productivity and achieve business results.

Discovering opportunities, support and excellence all while making a real difference in patients' lives begins at Mount Carmel. Find a new beginning and advance your career with us.

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities tha



See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Registered Nurse Full Time

Encompass Health

Posted 3 weeks ago

VIEW JOBS 11/20/2018 12:00:00 AM 2019-02-18T00:00 RNs, we have great benefits to offer you, such as opportunities for career advancement, Student Loan Forgiveness/Tuition Assistance, and a leading Compensation Package. Should you have questions or want to learn more about the exciting RN opportunities & benefits at this new hospital, please contact Merri Foltz at merri.foltz@healthsouth.com Mount Carmel Rehabilitation Hospital, in partnership with HealthSouth, is currently accepting applications for Full Time Registered Nurses for Day & Night Shifts. Mount Carmel Rehabilitation Hospital is located north of Mount Carmel St. Ann's near the southwest corner of Cleveland Avenue and Polaris Parkway. The 60-bed inpatient rehabilitation hospital is a joint venture between HealthSouth and Mount Carmel and provides specialized rehabilitative care to patients who have experienced stroke, trauma, brain and orthopedic injuries or other major illnesses or injuries. The 60,000-square-foot freestanding hospital includes 60 all-private rooms, a spacious, on-site therapy gym, a walking path and cutting-edge rehabilitation technologies Location: Address: 597 Executive Campus Drive, Westerville, Ohio 43082 EXPERIENCE HEALTHSOUTH Now Hiring HealthSouth Registered Nurses Helping patients regain hope and independence The Facts Act as the direct link to help patients succeed in inpatient rehabilitation by supervising care and treatments provided by team members, leading patient assessments, creating personalized plans of care, communicating progress and targeting patient concerns, offering timely solutions. The HealthSouth Difference The importance of nursing to HealthSouth rehabilitation hospitals can't be overstated. At HealthSouth, comprehensive rehabilitation is planned and administered by a highly specialized and integrated team including physicians, nurses, physical therapists, respiratory therapists, speech therapists, occupational therapists, case managers and others. Rehabilitation nurses are a valuable resource and bring an important perspective to this interdisciplinary approach. HealthSouth rehabilitation nurses help the patients regain control of their lives and their independence, treating complex medical issues and redefining how care is provided. The Perks Only the best will do * Comprehensive medical, dental and vision plans * 401(k) * College savings plan * Employee assistance program * Pre-paid legal plan * and much more! The Patients Eighty percent of patients discharged directly home Our registered nursing teams get to know patients over two to four weeks on average, providing care for conditions such as: * Stroke * Spinal cord injury * Brain injury * Neurological disorders * Joint replacement * Amputation * Multiple trauma The Power Advanced tools to support patient progress * Advanced technologies * Evidence-based practice guidelines * Clinical outcomes to assess and improve treatment interventions * National outcomes database * Trained mentors * Internal and external education * Professional treatment teams * Multiple trauma The Basics * Current RN licensures appropriate to state regulations * CPR certification (ACLS preferred) * CRRN certification preferred * One-year experience in inpatient rehabilitation hospital setting preferred Job Code: 100130 License or Certification: * Current RN licensures appropriate to state regulations * CPR certification (ACLS preferred) * CRRN certification preferred Education, Training and Years of Experience: * One year of experience in inpatient hospital setting preferred * Inpatient rehabilitation experience preferred Machines, Equipment Used: * General office equipment such as telephone, copy machine, fax machine, calculator, computer Physical Requirements: * Good visual acuity and ability to communicate * Ability to lift a minimum of 30 pounds and ability push/pull a minimum of 30 pounds, which includes the lifting, pushing and/or pulling of medical supplies and equipment and the transferring and repositioning of patients. Reasonable assistance may be requested when lifting, pushing, and/or pulling are undertaken which exceeds these minimum requirements * Ability to withstand prolonged standing and walking * Ability to reach, stoop, bend, kneel, and crouch are required for patient care functions and in setting up and monitoring equipment About HealthSouth HealthSouth is one of the nation's largest providers of post-acute healthcare services, offering both facility-based and home-based post-acute services in 33 states and Puerto Rico through its network of inpatient rehabilitation hospitals, home health agencies, and hospice agencies. HealthSouth can be found on the web at: www HealthSouth.com Address: 597 Executive Campus Drive, Westerville 43082 Shift: Day Job Job ID: 1623767 Encompass Health Westerville OH

Utilization Management Specialist (Registered Nurse Lead) Case Management Mount Carmel St. Ann's Full Time

Expired Job

Mount Carmel Health System