Utilization Review Nurse/Case Management Job at Grand Lake Health System, Ohio

UFg0S3YyZWYzeTdUMW1NY1ZIUFIreFFPQmc9PQ==
  • Grand Lake Health System
  • Ohio

Job Description

Hours of Job

  • Part Time - 40 hours/5 days per pay period
  • 7:30 AM-4:00 PM
  • Every third weekend rotation off-site; less than 3 hours per scheduled weekend
Duties and Key Responsibilities
  • The Utilization Review Coordinator reviews and clarifies patient status, applies initial and continued stay criteria to determine medical necessity, prepares clinical reviews to support payer authorization of hospital stays, and follows inpatient and observation cases through resolution with clear, trackable documentation in WellSky CarePort.
  • Follows secondary review process as necessary.
  • Provides continued stay reviews for behavioral health and attends the twice weekly team meetings.
  • Identifies and documents avoidable variances and denial activity. Arranges P2P appeals.
  • Audits and maintains compliance for IMM and MOON delivery.
  • Cross trains to other positions in Case Management for coverage needs
  • Must be receptive to changes as the position demands
  • Practices the Caring Model.
Requirements
  • Clinical/Psychosocial skills in acute care setting.
  • Strong team player with internal and external customers.
  • Must be adept and organized and work effectively and efficiently with staff and physicians
  • Patient advocacy, compliance, and confidentiality are a must.
Education/Certifications
  • Bachelor’s Degree from an accredited school is required.
  • Current Ohio Licensed Nurse.
Experience
  • Background in Nursing required with 5 years or more of recent acute care clinical experience.


Grand Lake Health System provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. GLHS complies with applicable state and local laws governing nondiscrimination in employment in all of our locations. In addition, Grand Lake Health System is an At-Will Employment employer.

Equal Opportunity Employer


This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

Job Tags

Part time, Local area

Similar Jobs

Ampro ADLINK Technology, Inc.

Firmware Engineer Job at Ampro ADLINK Technology, Inc.

 ...Primarily responsible for the development of Unified Extensible Firmware Interface (UEFI) Basic Input/Output System (BIOS) firmware...  ...to meet customer and or product needs. Work with hardware engineers to bring-up and debug products running a UEFI BIOS. Work... 

Impact Theory

Social Media Manager Job at Impact Theory

 ...requiring tight production, strong judgment, and thoughtful caller management to ensure emotionally safe, high-quality conversations....  ...executing. Role Overview Were looking for a Los Angelesbased Social Media Manager to own our short-form and professional social... 

Propio Language Services

Spanish Interpreter Job at Propio Language Services

 ...8 Propio Language Services provides critical interpreting and translation services that improve the quality of life with the communities...  ...in the industry.We currently have a need for Remote Contract Spanish Interpreters who have a sincere desire to use their language... 

Arsenault

Administrative Assistant / Data Entry Clerk (Remote Work From Home Online) Job at Arsenault

 ...Administrative Assistant / Data Entry Clerk (Remote Work From Home Online)Job Openings Administrative Assistant / Data Entry Clerk (Remote Work From Home Online)About the job Administrative Assistant / Data Entry Clerk (Remote Work From Home Online)Data Entry Administrative... 

Presbyterian Healthcare Services

Addiction Medicine Physician MD/DO - Espanola Job at Presbyterian Healthcare Services

 ...Presbyterian Espanola Hospital (PEH) PMG Renewal Clinic and the PEH Addiction Medicine Consult Service (inpatient and emergency department),...  ...AMCS and Renewal Clinic, taking advantage of the individual physicians training, experience, skills and preferences. For example:...