Utilization Review Manager - Home Care jobs in Milford, DE

Education: Must have a Bachelors degree; Masters degree or RN license preferred.

Assure residents meet criteria for admission, and review initial clinical information through discharge.

Monitor and manage client/patient/resident’s cases through development and implementation of individual care plans, collecting clinical data and remain informed by continuous review of documentation.

Coordinate care by tracking, monitoring, and reporting on inpatient or outpatient care.

Manage client/patient/resident’s cases with knowledge and expertise with the patient population of the facility.

Convey medical criteria and clinical information between the client/patient/residents’ insurance provider and treatment team as warranted and may also provide this information to the business office, as needed.

Conduct precertification with third party payers and negotiate approved days with the provider for the patient/resident admission.

Assigned tasks for admission review, concurrent review and participate in discharge planning.

Experience

• 1 year(s): Ability to create and maintain professional liaison with community agencies and organizations to ensure continuity of care. Knowledge of mental health and substance abuse fields is preferred.

Education

• Bachelors or better in Human Services or related field

• Masters or better in Human Services or related field

Licenses & Certifications

• Reg Nurse

Skills

• Customer Focus
• Communication

Behaviors

• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
• Team Player: Works well as a member of a group

Motivations

• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)