Utilization Management Nurse RN

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions. We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry. Overview Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time. How you Will make a difference Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations. Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately. Verify all care needs and the authorization for services and outliers. Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO. Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing Prepare all Managed Care documentation to facility accurate billing. What you Need to make a Difference Registered Nurse (RN) in good standing with required current state license. Associates degree required, but Bachelor’s degree preferred. Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual. Minimum of three (3) years related case management experience. Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience Certified in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment. Knowledge of Medicare payment methodology and the MDS RUG system. Previous experience with MDS and assessment preferred Our exceptional Benefits Package and Signature Perks include the following and more! Medical, Dental and Vision – Voluntary Life/Disability Free Telemedicine with Medical Plan 401(K) and Roth 401(K) Tuition Forgiveness/Education Reimbursement A variety of additional specialized Insurances Pay Advance and Next Day Pay! Paid Time Off (PTO) Partner Perks and Discounts! Reward & Recognition Program (HEART) Vital Links At Signature HealthCARE, our team members are permitted – no, encouraged – to employ their talents and abilities to solve problems. Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship. Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization. Come see what the revolution is all about! Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories Salary Range USD $75,000.00 - USD $82,000.00 /Yr. #J-18808-Ljbffr Signature Consulting Services LLC