Utilization Manager Job
Location: Nashville Tennessee
Description: Amerigroup is in need of Utilization Manager Job right now, this job will be placed in Tennessee. Detailed specification about this job opportunity please read the description below. Utilization Manager
Job ID 2013-22066 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..
More information about this job:Summary:
Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patientsâ health care needs without compromising quality outcomes.
Responsibilities:
1. Performs on-site and/or telephonic review of acute and sub acute services.
2. Predicts and plans for patientâs needs from pre-admission, through acute and sub acute care and post-discharge, in collaboration with the member.
3. Utilizes pre-approved criteria and guidelines to validate me! dical necessity of continued stay and appropriateness of treat! ment and discharge planning.
4. Acts in conjunction with the appropriate manager(s) on a daily basis to assess the inpatient census for appropriate alternative health care service needs.
5. Coordinates with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges.
6. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.
7. Acts in conjunction with the clinical team related to discharge planning (e.g., home care, hospice care, rehabilitation care, special program care, transitional care, occupational therapy, speech, respiratory and physical therapy), durable equipment and disposable supplies.
8. Documents all activities in the appropriate system(s) on a timely basis.
9. Pa! rticipates in rounds with the Medical Director.
10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.
11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.
12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.
13. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
Preferred:
Years and Type of Experience Required:
Required:
Preferred:
!
Certifications or Licensures
Required:
Preferred:
Language Skills
Required:
Preferred:
Functional Competencies
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Amerigroup.
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This job starts available on: Mon, 24 Jun 2013 07:01:32 GMT
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