Monday, June 24, 2013

Utilization Manager Job job at Amerigroup in Nashville

Amerigroup is in need of Utilization Manager Job on Mon, 24 Jun 2013 07:01:32 GMT. 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...

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 patients’ 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 patient’s 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:

  • Nursing Diploma.
  • Associate’s Degree in related Health/Nursing field.
Preferred:
  • Bachelor’s Degree in related Health/Nursing field.
Years and Type of Experience Required:
Required:
  • Minimum of two years of utilization management o! r hospital/acute care experience.
Preferred:
    !
  • Minimum of three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
  • Experience working on the community level and with community agencies.
Certifications or Licensures

Required:
  • RN
  • Must possess a valid driver’s license and access to a motor vehicle.
Preferred:
  • Certified Professional Healthcare Management
Language Skills

Required:
  • English
Preferred:
  • Bilingual
Functional Competencies
  • Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing syst! ems.
  • Experience working with utilization management data systems.
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.
  • Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
  • Ability to communicate both in person and/or by telephone.
  • Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
ermHO
- .
If you were eligible to this job, please email us your resume, with salary requirements and a resume to Amerigroup.

If you interested on this job just click on the Apply button, you will be redirected to the official website

This job starts available on: Mon, 24 Jun 2013 07:01:32 GMT



Apply Utilization Manager Job Here

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.