Weekday Optum Utilization Review Jobs Near Me

Select Specialty Hospital

Critical Illness Recovery Hospital (LTACH)

 Case Manager (PRN)

Requires a current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR  Social Work  SW/MSW (potential license per state guidelines).

And

Previous discharge planning experience highly preferred.

SHIFT:

*Availability to work a minimum of 2 shifts per month on an "as needed" basis - shifts would be scheduled on weekdays, from appoximately 8a.m.-5p.m.*

Our hospital is a critical illness recovery hospital committed to providing world-class inpatient post-ICU services to chronic, critically ill patients who require extended healing and recovery. We help patients during some of the most vulnerable, painful moments of their lives - and our team plays a central role in providing compassionate, excellent care every step of the way.

We are looking for valued employees who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right.

The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and financial management, while also completing medical record documentation. You will report directly to the Director of Case Management and provide social work services, as necessary, per state guidelines.

• Develops and implements a patient specific, safe and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Builds relationships and coordinate with payor sources to assure proper reimbursement for hospital provided services, promote costs attentive care via focus on resource management within the plan of care.
• Demonstrates compliance with facility-wide Utilization Management policies and procedures.
• Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintains fiscal responsibilities. Assures the department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient. Reviews insurance verification forms to minimize risk.
• Facilitates multi-disciplinary team meetings including physicians, nurses, respiratory therapists and rehabilitation therapists.

How you will be successful in this environment:

We are seeking results-driven team players. Qualified candidates must be passionate about providing superior quality in all that they do.

Minimum requirements:

• Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per state guidelines
• Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting dealing with critical care/acute care patients. (example: ICU, step-down, med surg, vents) 
• Adequate experience in an acute medical case management setting and confidence to manage and direct a plan of care for chronically critically ill populations

Preferred qualifications that will make you successful:

• Specific experience in Care Management and Discharge Planning is preferred.
• Working knowledge of the insurance industry and government reimbursement.

• Availability to work a minimum of 2 shifts per month on an "as needed" basis - shifts would be scheduled on weekdays, from appoximately 8a.m.-5p.m.

Why Join Us:

• Start Strong: Extensive orientation program to ensure a smooth transition into our setting.
• Opportunity for Advancement: Demonstrate your skills and dedication which could lead to potential full-time opportunities
• Foster Well-being: We offer benefits which support the financial, work/life and emotional well-being of you and your family members.  Part time/Per Diem positions are eligible for 401k based on reaching 1,000 hours within their first anniversary or subsequent calendar year. We also offer our employee assistance program to part time employees.
• Your Impact Matters: Join a team of over 44,000 committed to providing exceptional patient care

Equal opportunity employer, including disabled veterans