Utilization Review Manager - Home Care jobs in the United States

Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Utilization Review Case Manager
  • PALO VERDE HEALTH CARE DISTRICT
  • Blythe, CA OTHER
  • Job Details

    Job Location:    Palo Verde Hospital - Blythe, CA
    Salary Range:    $45.00 - $55.00 Hourly

    Description

    Welcome to Palo Verde Healthcare District, which operates under the name Palo Verde Hospital. Our employees are an important part of an organization dedicated to providing safe, effective, and quality medical care services for the benefit of the entire community. Our success is built upon the talents and contributions of each employee and on working as a team to achieve our goals. The more we work together, the more we can progress as individuals and as an organization and the better we can serve our community.

     

    Do you thrive in a collaborative environment where you can contribute to the well-being of your community? If so, we have an exciting opportunity for you to join our team!

     

    Position: Utilization Review Case Manager

    Employment Type: Per Diem, 8 hour days, weekdays and Weekend Shifts

     

    Job Summary: The Utilization Review (UR) Case Manager ensures that patients are placed at the most suitable level of care according to nationally accepted admission criteria. Utilizing medical necessity screening tools, the UR Case Manager conducts initial and ongoing reviews to determine the appropriate level of patient care and estimate the expected length of stay. The UR Case Manager obtains authorization for clinical services through prompt collaboration and communication with payers. The UR Case Manager serves as a liaison between patients, families, and healthcare providers. 

     

    Key Responsibilities:

    1. Patient Assessment and Care Planning:

      • Conduct comprehensive assessments of patients’ medical, psychosocial, and functional needs.
      • Develop individualized care plans in collaboration with the healthcare team.
      • Monitor and modify care plans as needed to ensure they meet patients’ changing needs.
    2. Coordination and Communication:

      • Act as a primary point of contact for patients and families, providing education and support throughout the care continuum.
      • Facilitate communication between patients, families, healthcare providers, and resources.
      • Coordinate discharge planning, ensuring a smooth transition from hospital to home or other care facilities.
    3. Resource Management:

      • Identify and connect patients with appropriate resources and services, including financial assistance, transportation, and community support.
      • Advocate for patients to obtain necessary services and support.
      • Manage utilization of hospital resources

    4. Documentation and Compliance:

      • Maintain accurate and timely documentation of patient assessments, care plans, and interventions.
      • Ensure compliance with hospital policies, procedures, and regulatory requirements.
      • Participate in quality improvement initiatives and data collection for performance measurement.
    5. Collaboration and Teamwork:

      • Work closely with physicians, nurses, social workers, and other healthcare professionals to ensure comprehensive care.
      • Participate in interdisciplinary team meetings to discuss patient progress and care strategies.
      • Contribute to staff education and training on case management practices.

    Qualifications


    Qualifications:

    • Associate Degree/College Diploma from an accredited nursing program required. Bachelors Degree in Nurse preferred.

    • Current California licensure as a Registered Nurse (RN). 

    • Minimum of 2 years of clinical experience in a hospital or healthcare setting, with experience in case management or discharge planning preferred. 

    • Minimum of 3 years Acute Care experience preferred.

     

     

    Join our team and make a difference in the lives of our patients! To apply, please submit your resume and a cover letter outlining your qualifications and why you are interested in this position.

     

    Palo Verde Hospital is an equal opportunity employer and is committed to diversity in the workplace. We encourage all qualified individuals to apply.

    **Candidates whom are offered a position are required to submit to a pre-hire screening including a background check, drug screen, and reference check.

  • 8 Days Ago

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Nurse Clinician - Utilization Review - Downtown Campus 60%
  • Utilization Review - Downtown Campus 60% - Jobs@UIOWA Careers
  • Iowa, IA FULL_TIME
  • The University of Iowa Healthcare Downtown Campus, Utilization Review team is looking for a Nurse Clinician to functions as a clinical nurse expert and clinical coordinator acting as nurse liaison to ...
  • 4 Days Ago

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Registered Nurse - Behavioral Health Utilization Review
  • Behavioral Health Utilization Review in Owensboro, KY - Owensboro
  • Owensboro, KY FULL_TIME
  • Summary Job Summary Provides direct nursing care in accordance with established policies, procedures, and protocols of the healthcare organization. Job Responsibilities Implements and monitors patient...
  • 1 Month Ago

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Care Manager MSW - Utilization Review
  • Providence Health
  • Olympia, WA FULL_TIME
  • Description SCHEDULE: 8 hour shifts, flexible start time 07-0830 Under supervision of Care Management Manager, works as a catalyst to promote the following: coordination of care, continuity of care, a...
  • 1 Month Ago

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Nurse Care Manager & Utilization Review
  • Gillette Children's
  • Paul, MN PART_TIME
  • The Inpatient Nurse Care Manager & Utilization Review position is a 0.6 FTE (48 hours p/pay period). This role will be scheduled days, Wednesday-Friday, between the hours of 7:00am - 5:00pm. Purpose o...
  • 25 Days Ago

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Utilization Review /Care Manager RN
  • Epsilon Solutions
  • Kealakekua, HI CONTRACTOR
  • Hiring for Utilization Review /Care Manager RN. Works a case manager/utilization review RN. Day shift with some weekends possible. Must have medical and Mental Health/Psych experience Shift Informatio...
  • 26 Days Ago

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HCBS Utilization Management Nurse
  • Optum
  • Mount Vernon, VA
  • $5,000 Sign On Bonus for External Candidates For those who want to invent the future of health care, here's your opportu...
  • 11/12/2024 12:00:00 AM

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HCBS Utilization Management Nurse
  • Optum
  • Annandale, VA
  • $5,000 Sign On Bonus for External Candidates For those who want to invent the future of health care, here's your opportu...
  • 11/12/2024 12:00:00 AM

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HCBS Utilization Management Nurse
  • Optum
  • Springfield, VA
  • $5,000 Sign On Bonus for External Candidates For those who want to invent the future of health care, here's your opportu...
  • 11/12/2024 12:00:00 AM

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HCBS Utilization Management Nurse
  • Optum
  • Washington, DC
  • $5,000 Sign On Bonus for External Candidates For those who want to invent the future of health care, here's your opportu...
  • 11/12/2024 12:00:00 AM

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HCBS Utilization Management Nurse
  • Optum
  • Glenelg, MD
  • $5,000 Sign On Bonus for External Candidates For those who want to invent the future of health care, here's your opportu...
  • 11/12/2024 12:00:00 AM

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HCBS Utilization Management Nurse
  • UnitedHealth Group
  • Washington, DC
  • $5,000 Sign On Bonus for External Candidates For those who want to invent the future of health care, here's your opportu...
  • 11/11/2024 12:00:00 AM

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Data Science Project Manager (Facility and Utility Management) - NIH
  • Kelly
  • Bethesda, MD
  • Kelly Government Solutions is a strategic supplier and business partner to the federal government and its key suppliers....
  • 11/11/2024 12:00:00 AM

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Travel Nurse Manager RN - Case Management - $3,200 per week
  • Hiring Now!
  • Silver Spring, MD
  • Trinity Health FirstChoice is seeking a travel nurse RN Case Management Manager for a travel nursing job in Silver Sprin...
  • 11/11/2024 12:00:00 AM

Income Estimation for Utilization Review Manager - Home Care jobs
$77,361 to $98,622