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)
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:
Patient Assessment and Care Planning:
Coordination and Communication:
Resource Management:
Manage utilization of hospital resources
Documentation and Compliance:
Collaboration and Teamwork:
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.