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Utilization Review Case Manager

Company

Lehigh Valley Health Network
Address , Allentown, 18103
Employment type FULL_TIME
Salary
Expires 2023-10-08
Posted at 9 months ago
Job Description

**FULLY REMOTE

Job Summary:
Ensures appropriate use of hospital resources by reviewing all patients admitted to the hospital and evaluating appropriateness of admission using approved criteria. Ensures appropriate patient class assignment (inpatient, outpatient) to ensure compliance with third party payer requirements.

Education - Required:

  • Specialized Diploma in nursing

Education - Preferred:
  • Bachelor's Degree In nursing

Experience - Required:
  • 2 years of previous utilization review experience. and
  • 2 years Knowledge of utilization management as it relates to third party payers.

Experience - Preferred:
  • 5 years of experience in case management and DC planning experience within the last 5 years.
  • 3 years of experience in acute care and



Knowledge, Skills, and Abilities - Required:
  • Demonstrates proficiency with all work queue processes.
  • Ability to complete work assignments accurately and in a timely manner while managing multiple responsibilities and prioritizing all tasks effectively.
  • Ability to work in a team environment demonstrating flexibility to work toward common goals based around prioritized needs.
  • Ability to be attentive to detail and maintain a positive attitude.
  • Ability to maintain the strictest adherence to HIPAA while maintaining confidentiality of all PHI.
  • Knowledge of evidence-based clinical decision support criteria.



Knowledge, Skills, and Abilities - Preferred:
  • Knowledge of evidence-based criteria such as InterQual criteria and/or MCG criteria.



Licensure - Required:
  • Registered Nurse Upon Hire



Licensure - Preferred:
  • CMCN - Certified Managed Care Nurse Upon Hire
  • ACM - Accredited Case Manager Upon Hire and
  • CCM - Certified Case Manager Upon Hire and

Location: Lehigh Valley Health Network · Utilization Management
Schedule: Full Time 40 hours, Day Shift, 0600-1630