Case Manager - Utilization Review Specialist - REMOTE

Pay $32.15 - $48.05 / hour

Location:

Springfield/Oregon

Employment type:

Full-Time

• Req#: CASEM
  027065
• Hourly Base Rate: $32.15 - $48.05
• Shift: Day Shift - Remote
• Hours Per Week: 40-hours
• Date Posted: 6/1/2023

Job Summary:

• Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies.
• Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.
• Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
• Abstracts data from records and maintains compliance with established standards.

Educational/Licensure:

• Current Oregon RN state license, or current State RN license and ability to obtain OR RN license within 6 months of hire.
• Knowledge in areas such as Inter Qual Level of Care Criteria and Milliman & Robertson Criteria as well as knowledge of third party payer regulations related to utilization and quality review is also preferred.

Qualifications:

• Significant experience in the healthcare field is required including a minimum of five years as a clinical nurse in an acute care setting.
• At least five to seven years of experience in case management, discharge planning, and/or utilization review is preferred.
• Knowledge of regulatory and payer requirements for Case Management Activities.
• Ability to critically evaluate and make decisions about discharge planning for highly difficult cases.

Preferred:

Bachelor's Degree

Required:

L-OR-RN License

McKenzie-Willamette Medical Center is an acute care hospital located in Springfield, Oregon, United States.