UM Case Manager – Utilization Management
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Job Description
UM Case Manager at McLeod Health coordinating patient care through acute settings and ensuring reimbursement processes. Responsible for quality assurance and improvement in care.
Responsibilities:
- Coordinates/facilitates patient care progression throughout the continuum of care.
- Assures the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
- Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered.
- Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas.
- Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors.
- Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form.
- Ensures that all payer communication is documented for the care team as well as billing.
- Ability to cover various populations across the organization in relation to Utilization Review.
- Performs all other duties as requested by Case Manager Supervisor and/or Director.
Requirements:
- 1-2 years of recent acute care hospital experience required
- Data entry/computer experience required
- Registered Nurse
Benefits:
- Health insurance
- Retirement plans
- Paid time off
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