UM Case Manager - Utilization Management
McLeod Health
Job Title
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.
Qualifications
1-2 years of recent acute care hospital experience required
Data entry/computer experience required.
Requirements
Licenses and Certifications: Registered Nurse
About Us
Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.
About the Team
If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply online today. We are an equal opportunity employer.
Job Info
Job Identification 26038
Job Category Nursing
Degree Level Associate Degree
Job Schedule Part time
Locations 801 E Cheves St, Florence, SC, 29506, US (Remote)
- ...Job Opportunity We are recruiting for an RN or LVN Case Management with strong UM skills. Utilization Management. Shift is 0800-1700. Strong UM Review nurses, LVN or RN Candidate MUST have UM Review experience, Aware of Turn-Around-Time for all Lines-of business, Familiar...SuggestedWeekly payDaily paidContract workFlexible hoursShift work
Care Navigators On Demand
Whittier, CA1 day ago $153.49k - $202.43k
Job Title CASE MGR EX CEH Department PHSO - CLINICAL OPERATIONS Hiring Pay Scale... ...S. hospitals. The Prior Authorization UM Case Manager is responsible for managing the prior authorization... ...RN experience in prior authorization, utilization management, or a related healthcare...SuggestedHourly payContract workLocal areaRemote workMonday to FridayDay shift1 day per week$95k - $105k
...Inpatient Case Manager HealthCare Partners, IPA and HealthCare Partners, MSO together comprise... ...quality of care while efficiently utilizing healthcare resources. HCP's vision is to... ...Prior experience in utilization management (UM), inpatient case management, or care...SuggestedLocal areaHealthCare Partners of Nevada
Garden City, NY1 day ago- ...provide, ongoing coordination and management of service delivery through an integrated case management approach • Performs... ...quality standards related to Utilization Management • Maintain and submit... ...activities as outlined by the UM program operational procedures,...SuggestedPermanent employmentFull timeWork at office
1199 Seiu National Benefit Fund
New York, NY4 days ago - ...Utilization Review Case Manager Dilkon Medical Center - Dilkon, AZ 86047 Overview Level: Experienced Position Type: Full-Time Job Shift: Day Education Level: Bachelors Degree Travel Percentage: Negligible Description Under general supervision of the PRC...SuggestedFull timeWork at officeFlexible hoursShift workNight shiftAfternoon shift
WIHCC
Winslow, AZ5 days ago - ...Utilization Management Case Manager Santa Barbara Cottage Hospital seeks a Utilization Management Case Manager for their Care Management department responsible for the utilization management, quality assurance, and discharge planning activities for assigned services...Work experience placementShift work
Cottage Health
Santa Barbara, CA5 days ago $89.76k - $127.98k
...Utilization Review and Appeals Case Manager Position Summary This position is responsible for performing utilization management and concurrent review activities to ensure appropriate level of care determinations for patients receiving inpatient, observation, emergency...Full timeWork at officeFlexible hoursShift workWeekend workDay shiftWeekday workStony Brook University
Stony Brook, NY4 days ago$89.76k - $127.98k
...Position Summary This position is responsible for performing utilization management and concurrent review activities to ensure appropriate level... ...environment. Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to:...Full timeWork at officeFlexible hoursWeekend workDay shiftWeekday workStony Brook Medicine
Stony Brook, NY3 days ago- ...Utilization Review Nurse Works under the supervision of the Director of Care Management. Reviews the medical record on a concurrent basis, utilizing criteria accepted and approved... ...and resource in Utilization Review and Case Management. Partners with Social Workers to...Work experience placement
Holzer Health System
Gallipolis, OH3 days ago - ...Emergency Department Case Manager/Utilization Manager RN At UNC Health Blue Ridge, we live our mission by enhancing the lives of every patient and resident we serve. We believe our people are our greatest asset and strive to provide an environment where they can thrive...
UNC Health Blue Ridge
Morganton, NC4 days ago - ...The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management... ...during and outside of IDRs. Annual Initiatives: Develops UM/resource management studies and projects including fiscal...Work experience placement
- ...Follow the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions... ...outcomes, and appropriate financial management for the patient and the organization... ...experience required ~2+ years of case management experience preferred ~ Knowledge...Daily paidSeasonal work
- ...Utilization Management Case Manager Havenwyck Hospital (a UHS facility) is a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan. We specialize in providing comprehensive, compassionate behavioral health...Local area
$55.56 - $85.96 per hour
...Utilization Review Case Manager Under general supervision, the Utilization Review Case Manager performs review of patient charts as defined by the Hospital's Utilization Review Plan. The UR CM validates the patient's admission status and level of care to be at the most...Contract work$65 per hour
...Job Description Job Description RN Case Manager / Utilization Review - Syracuse, NY (#25268) Location: Acute Care/Academic Medical Center, Syracuse, NY Employment Type: Full-time Hourly Rate: $65/hour About Greenlife Healthcare Staffing: Greenlife...Hourly payFull timePrivate practiceMonday to FridayDay shiftGreenLife Healthcare Staffing
Syracuse, NY25 days ago- A leading cancer treatment facility in Florida is seeking a Case Manager responsible for coordinating care for specific patient populations... ...nursing. Responsibilities include discharge planning and utilization review for inpatients, emphasizing leadership and effective resource...
- ...continue learning and understanding their needs and practicing self‑care for the rest of their lives. Position Summary The Utilization Management Case Manager has a responsibility for organizing and conducting the manager care process. These duties shall be directed...Local area
- Select Medical in Des Moines, Iowa is seeking a Case Manager to oversee utilization reviews, discharge planning, and resource management. Candidates must possess current licensure as a Nurse or Respiratory Therapist and have experience in inpatient settings dealing with...Full time
- Select Medical seeks a full-time Case Manager at Select Specialty Hospital in Mount Clemens, Michigan. This role involves developing discharge plans, performing utilization reviews, and managing resources for critically ill patients. The ideal candidate will have a current...Full time
- ...Position Summary: The Registered Nurse Non-Certified Case Manager works with physicians and multidisciplinary team members to develop... ...Association BLS Minimum of 2 years of nursing experience MUST HAVE UTILIZATION REVIEW EXPERIENCE Preferred Bachelor's Degree in Nursing 2...Shift workDay shift
Reliant Staffing Solutions
Bozeman, MTa month ago $32 - $48 per hour
...better health. Position Overview: The Utilization Review Specialist RN assumes... ...all payers, as well as coordination and management of appeals for accounts deemed appropriate... ...Utilization Review Specialist RN - Department: Case management -Location: Gateway...Hourly payFull timeGateway Regional Medical Center
Granite City, IL1 day ago- ...RN, Utilization Case Manager - Archimedes Location US-MO-Earth City ID 2026-5979 Category Archimedes Position Type Full-Time Company Archimedes About Us Archimedes - Transforming the Specialty Drug Benefit -...Full timeWork at officeFlexible hours
Navitus Health Solutions
Earth City, MO4 days ago $46.44 - $69.66 per hour
...less Shift (United States of America) Department 8790 Case Management The RN Case Manager assesses plans, coordinates care,... ...case manager and other disciplines which enhances appropriate utilization of post-acute levels of care. Facilitates transition of patient...Full timeShift workKAWEAH HEALTH
Visalia, CA3 days ago- ...Utilization Management Case Manager/Appeal Coordinator Havenwyck Hospital (a UHS facility) is a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan. We specialize in providing comprehensive, compassionate...
- A healthcare provider in Escondido, California, is seeking a registered nurse for utilization management. The role involves assessing discharge plans, participating in patient rounds, and ensuring compliance with medical appropriateness criteria. Candidates should have...
$31.94 - $43.92 per hour
...+ psychosocial assessments Create and manage discharge plans Coordinate with MDs, nurses... ...Lead care planning discussions Utilization Management Review medical necessity &... ...Requirements Option 1: 3+ years recent Case Management (acute care) OR Option 2: 3...Relocation packageShift workWeekend workAfternoon shiftLancesoft INC
Tallahassee, FLa month ago- Havenwyck Hospital in Auburn Hills, Michigan, is seeking a Utilization Management Case Manager to support our mission in providing excellent behavioral health services. The role involves organizing care management, conducting reviews for reimbursement processes, and collaborating...
- ...services. These programs emphasize symptom management, community integration, and prevention... ...or re‑hospitalization. UR Case Manager Responsibilities Conducts admission... ...payers Maintains appropriate records of the Utilization Review Department Participates in activities...Work at officeLocal area
- ...leading healthcare company is seeking a Behavioral Health Care Manager I to manage psychiatric treatment and substance abuse disorder... ...are essential. Ideal candidates should have experience in utilization management and possess strong communication and analytical skills...
- A leading healthcare provider is looking for a Utilization Management Case Manager in Auburn Hills, Michigan. This role involves supporting the hospital's mission by overseeing the management care process while working collaboratively across departments. The ideal candidate...
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