Utilization Review Case Manager Job Idaho Falls area,Idaho USA,Nursing

Position: UTILIZATION REVIEW CASE MANAGER

Job Details

Position:
Utilization Review Case Manager

Location:

Idaho Falls,

Type:
Full Time

Education Level: Registered Nurse (or Licensed Practical Nurse in the State of Idaho)

Job Summary

Under the general direction of the UR/Case Manager and the UR Medical Director, the Utilization Review Nurse is responsible for ensuring prompt, accurate handling of initial medical necessity reviews through the preauthorization and retrospective review process.

Benefits

Medical, Dental and Vision Insurance
Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
Retirement Plans (401K with up to 6% match)
Earned Quarterly Bonus Program
Education Reimbursement Program
Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Duties and Responsibilities

Perform initial and concurrent review of inpatient cases applying evidence-based criteria (Interqual Criteria).

Discuss cases with facility healthcare professionals to obtain plans of care.

Participate in discussions with the UR Medical Director, Hospitalists, Nurses and Case Managers to improve the progression of care to the most appropriate level.

Consult the UR Medical Director, as needed, for complex cases.

Apply clinical expertise when discussing cases with internal and external case managers and physicians.

Identify delays in care or services and manage with physicians.

Follow all company procedures in end-to-end management of cases.

Obtain clinical information to assess and expedite alternate levels of care.

Follow up with UR Medical Director for denied cases for peer-to-peer reviews.

Maintain a good working relationship both within the department and with other departments.

Participate in the educational program, complete annual educational requirements, and attend in-service meetings as required.

Attend all other meetings prepared and ready to participate as required.

Maintain patient confidentiality at all times.

Accept and complete other duties as assigned or requested.

Maintain accurate time clock punches, punch in and out according to hospital policy. Follow hospital sick policy for calling in on scheduled day to work.

Answer incoming calls to the facility in a professional, timely manner.

Maintain a professional attitude.

Wear appropriate clothing according to dress code.

Keep a current list of all patients, accounts and insurance carriers.

Keep all forms current and make changes when needed.

Keep all equipment and materials working properly and maintain as needed.

All other duties as assigned.

Qualifications

Must be a Registered Nurse or Licensed Practical Nurse in the State of Idaho.
Minimum 3+ years of clinical nursing experience practicing clinically; preferred experience with Utilization Management and Interqual.
Ability to use hospital information system, operate computer functions and software.
Ability to write routine reports and correspondence; speak effectively with physicians, supervisors, nurses, and case managers.
Mathematical skills: add, subtract, multiply, divide in all units of measure, use of whole numbers, common fractions, decimals; compute rate, ratio, percent; interpret bar graphs.
Ability to apply common sense to carry out instructions in written, oral, or diagram form; handle problems involving several concrete variables in standardized situations.
Ability to work well with others.

#J-18808-Ljbffr