Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and ... Actively participates in clinical case review/rounds with the interdisciplinary team. * Documents ...
Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and ... Actively participates in clinical case review/rounds with the interdisciplinary team. * Documents ...
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization. What makes ...
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization. What makes ...
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization. What makes ...
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization. What makes ...
RN - Case Management
Detroit, MI · On-site
$2.1K/wk
... Case Manager - Utilization Review Nurse Schedule: Shift: 08:00 - 16:30 Assignment Details ... Contract Length: 12 weeks - Guaranteed Hours: 40 hours per week Requirements: - Active nursing ...
RN - Case Management
Detroit, MI · On-site
$2.1K/wk
... Case Manager - Utilization Review Nurse Schedule: Shift: 08:00 - 16:30 Assignment Details ... Contract Length: 12 weeks - Guaranteed Hours: 40 hours per week Requirements: - Active nursing ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Certification in Case Management, either CCM or ACM (Commission for Case Management or American ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Certification in Case Management, either CCM or ACM (Commission for Case Management or American ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Certification in Case Management, either CCM or ACM (Commission for Case Management or American ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Certification in Case Management, either CCM or ACM (Commission for Case Management or American ...
... case finding and case record review, protocol updates, and quarterly and end of year activity ... Utilization Management Program Plan Provide lead clinical support and participation on Region 10 ...
... case finding and case record review, protocol updates, and quarterly and end of year activity ... Utilization Management Program Plan Provide lead clinical support and participation on Region 10 ...
The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans while assuming a leadership role in achieving desired clinical, financial and resource utilization ...
The Registered Nurse Case Manager assumes overall accountability for patients' discharge plans while assuming a leadership role in achieving desired clinical, financial and resource utilization ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Certification in Case Management, either CCM or ACM (Commission for Case Management or American ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Certification in Case Management, either CCM or ACM (Commission for Case Management or American ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
This position integrates national standards for case management scope of services including ... Utilization Management supporting medical necessity and denial prevention. Transition Management ...
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
Case Manager-Social Worker MIDNIGHTS
Detroit, MI · On-site
$21.50 - $28.25/hr
Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Desire to work collaboratively and proactively with healthcare teams ...
Case Manager-Social Worker MIDNIGHTS
Detroit, MI · On-site
$21.50 - $28.25/hr
Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Desire to work collaboratively and proactively with healthcare teams ...
Utilization Case Manager information
What is a utilization case manager?
A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.
How does a utilization case manager typically collaborate with healthcare providers and insurance companies?
Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.
What degree do I need for utilization review?
Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.
What are the key skills and qualifications needed to thrive as a utilization case manager?
To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.
What is the difference between Utilization Case Manager vs Utilization Review Nurse?
| Aspect | Utilization Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, case management certification | RN license, certification in utilization review |
| Work Environment | Case management teams, hospitals, insurance companies | Utilization review departments, hospitals, insurance providers |
| Primary Focus | Coordinating patient care, discharge planning, resource allocation | Assessing medical necessity, reviewing patient records for appropriateness |
| Common Usage | Broader case management roles, patient advocacy | Specific review of medical necessity and insurance claims |
While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.
What are popular job titles related to Utilization Case Manager jobs in Michigan?
For Utilization Case Manager jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Michigan look for?
The top searched job categories for Utilization Case Manager jobs in Michigan are:
What cities in Michigan are hiring for Utilization Case Manager jobs?
Cities in Michigan with the most Utilization Case Manager job openings:
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Job description
Nurse
Position Summary: Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top decile performance in length of stay, cost efficient resource utilization, preventing readmissions and unnecessary emergency room visits. Works collaboratively with physicians, nursing, members of the multidisciplinary team (such as Home Care and PCP offices), as well as other resources internal and external to the organization.
Essential Functions and Responsibilities:
- Performs care coordination assessments for initial assessment of patients with 24 hrs. of admission. assessments for readmission and transition planning.
- Works collaboratively with the social worker and other disciplines to ensure a safe, appropriate, and timely transition to the next level of care, taking into consideration the patient's available resources.
- Assesses patient/family needs to reduce barriers and formulate discharge plans (e.g. LOS barriers to D/C).
- Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers.
- Reviews current DRG/LOS identified within Cerner to assess discharge planning needs with providers and identifies which family member is the point of contact.
- Assesses risk of readmission for specified patient populations and initiates assigned interventions that will enhance the patient's ability to successfully transition along the care continuum.
- Performs discharge planning coordination/referral by making appropriate referrals to social services, ancillary departments, outpatient case management, DME, post-acute placement, and other outside agencies per Standard Operating Procedure (SOP).
- Acts as a liaison by collaborating and communicating daily with the physician, patient, family, nursing, and other members of the healthcare team.
- Actively participates in clinical case review/rounds with the interdisciplinary team.
- Documents in the electronic medical record (EMR): assessment, plans, interventions, barriers, and reassessments to facilitate discharges and/or transitions, manages anticipated discharge date and ensures all pertinent information is transferred to post-acute agency.
- Identifies barriers early in the patient's stay, formulating a plan with the patient, family, internal and external members of the healthcare team, payers, and community resources.
- Identifies and reports avoidable day/variances and/or service delays from established plan of care to leadership.
- Represents the integrated care management department on various teams and performance outcomes committees and projects.
- Ensures patients follow up appointment with PCP has been made prior to discharge.
- Maintains effective operations by following policies and procedures.
- Performs other related duties as required and directed.
Required:
- Bachelor's degree in nursing from accredited educational institution, or actively pursuing degree and to be obtained within three years of accepting position
- State licensure as a Registered Nurse (RN)
- Minimum experience of three years in acute hospital setting
- Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association or equivalent through the Military Training network (MTN)
Preferred:
- Utilization management (review) and discharge planning experience.
- Certification in Case Management, either CCM or ACM (Commission for Case Management or American Case Management Association)