Utilization Review Care Manager

Utilization Review Care Manager

Part Time Weekend

Remote or Onsite

Position Summary

Responsible for coordinating communication between the hospital and third party payors to ensure care delivered in the hospital setting will be reimbursed. Minimizes denials by third party payors by communicating clinical information timely. Completes appeals for clinical denials timely and effectively.

Overview

The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.

Qualifications

     Knowledge, Skills and Abilities 

• Excellent customer service skills
• Reads and understand the English language.
• Ability to think critically and analytically with little or no supervision.
• Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.
• Ability to process information and prioritize
• Possesses exceptional verbal and written communications skills
• Ability to learn, adapt and change as required by the job functions.
• Ability to maintain absolute confidentiality for material and information accessed and reviewed
• Basic computer literacy 
• Ability to move freely, reach, bend and complete light lifting.
• Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines.
• Ability to maintain attendance to meet standard job practices.

    Education

• LPN or RN

    Licensure

• Current GA Nursing License in good standing with the GA board of Nursing

    Experience

• Minimum of three years varied hospital experience or comparable job related experience
• 3-5 years of utilization review, preferred.