Top 9 Utilization management nurse Jobs in Beckley Wv

Care Manager
Appalachian Regional Healthcare, Inc. —Beckley, WV
- Full-time
- Nursing
- RN License
- 5 years
10d
Nurse Practitioner (F2F)
MTC Care —Beckley, WV
- From $135,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- Microsoft Outlook
Psychiatric Mental Health Nurse Practitioner (PMHNP) (In-person)
MTC Care —Beckley, WV
- From $145,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- Microsoft Outlook

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Nurse Practitioner (F2F)
MTC Care —Beckley, WV
Unrestricted license in the state at least one state in which MTC Care practices. Respond to urgent calls from the facility and facilitate problem-solving.
From $135,000 a year

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Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department…
$62,500 - $79,800 a year
3d
Clinical Finance Case Management Specialist 2
The Ohio State University Wexner Medical Center —Columbus, OH
Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required.

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utilization management nurse jobs near beckley wv

Care Manager

Appalachian Regional Healthcare, Inc. -
Beckley, WV

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Job Details

Full-time
10 days ago

Qualifications

Team leadership
Computer literacy
Maintaining patient confidentiality
Leading team collaboration initiatives
Computer skills

Full Job Description

Overview

The Care Manager is accountable for outcomes as related to providing coordination of patient management through the continuum of care. Responsible for financial, clinical, and discharge planning evaluation for each assigned patient. Assures payment for services rendered, coordinates care, manages resources, and facilitates each patient encounter for efficient and effective outcomes as related to quality, clinical and cost areas.

Special Instructions

Coordinates comprehensive patient care across the healthcare continuum by assessing clinical and psychosocial needs, facilitating appropriate levels of care and discharge planning, coordinating services and resources, and collaborating with physicians, nursing, and payers, and interdisciplinary teams. Monitors length of stay, medical necessity, utilization, barriers to discharge, discharge readiness, and readmission risk while advocating for safe, timely cost-effective patient outcomes.

Responsibilities

Manages an assigned caseload of patients from preadmission to discharge.
Assumes responsibility for admission appropriateness (medical necessity), (outpatient, observation, inpatient admission), continued stay, and medical record monitoring
Coordinates communication with third party payers, external review agencies and the Utilization Committee.
Identify managed care issues and address promptly as related to denials management
Coordinates and collaborate with physicians, provider, multidisciplinary team and other health care professionals concerning patient’s goals, plan of care and progress.
Revise and adjust on a daily basis the plan of care to accommodate the needs of the individual patient based on continuing assessment of patient condition.
Leads discharge planning multidisciplinary team meetings, ensures documentation of meetings
Advocate for the patient/family and is knowledgeable of and act in accordance with legal principles of consent, healthcare proxies (power of attorney for healthcare) and advance medical directives.
Stays abreast of developments in the case management field and seeks ongoing education to enhance practice skills. Care Management is willing to seek certification in case management field if made available through ARH.
Stays abreast of regulatory agency guidelines as pertains to area of practice
Initiate and monitor clinical care guidelines and analyze positive and negative variances
Ensure continuity of care through formulation of discharge plan on admission and follow though until patient is discharged.
Ensure appropriate use of resources.
Monitor patient care for appropriate use of resources.
Monitors length of stay on a concurrent, weekly, and monthly basis. Ensures that length of stay is appropriate based on medical necessity. Works with medical staff, hospital staff, and others to overcome barriers to discharge.
Monitors in-house denials for extended lengths of stay.
Participates in the denials management process to help ensure establishment of and adherence to processes that will minimize denials by third-party payers.
Participates as a member of the Utilization Committee
Assists in the collection of data to trend and analyze outcomes for identification of improvement opportunities.
Participates in data collection, specific to outcomes data.
Assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.
Performs other related duties as assigned.

Qualifications

Required Education

Associate Degree in Nursing from an accredited school of nursing and current Registered Nurse (RN) licensure in the state of employment preferred.
Bachelor of Science in Nursing (BSN) preferred and must be obtained within five (5) years of hire.

Preferred Experience

Four (4) to six (6) years of nursing experience preferred.
Five (5) years of nursing experience may be considered with demonstrated skills required for the position.

Required Skills, Knowledge, and Abilities

Advanced problem-solving and decision-making skills.
Strong multitasking abilities with the ability to manage competing priorities and deadlines; flexible and adaptable.
Ability to interact tactfully and professionally with patients, families, staff, and community members.
Advanced communication skills with the ability to lead and support a team.
Advanced planning, execution, delivery, and operational support skills.
Ability to evaluate the relative costs and benefits of potential actions and make sound decisions.
Ability to function effectively in a clinical setting with diverse patient populations and healthcare teams.
Mastery of care transition processes and available patient resources.
Strong digital literacy and technology skills.
Ability to handle sensitive and confidential information ethically and responsibly.

Licenses and Certifications

Required

Licensed Practical Nurse (LPN) licensure.

Preferred

Registered Nurse (RN) licensure.

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Refine Your Search

utilization management nurse jobs in beckley wv

Care Manager

Nurse Practitioner (F2F)

Psychiatric Mental Health Nurse Practitioner (PMHNP) (In-person)

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I want to receive the latest job alert for utilization management nurse in beckley wv

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Overview

Special Instructions

Responsibilities

Qualifications

Required Education

Preferred Experience

Required Skills, Knowledge, and Abilities

Licenses and Certifications

Required

Preferred

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