Top 8 Utilization review nurse Jobs in Beckley, Wv

Care Manager
Appalachian Regional Healthcare, Inc. —Beckley, WV
- Full-time
- Nursing
- RN License
- 5 years
3d
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
Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract
Walker Healthforce, LLC —United States
- Contract
- Remote
- Nursing
- RN License
- 3 years
- Health insurance
- Dental insurance
Quick Apply
3d
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Care Manager
Appalachian Regional Healthcare, Inc. —Beckley, WV
Care Management is willing to seek certification in case management field if made available through ARH. Associate's Degree Registered Nurse (licensed in state…
3d
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Charleston Area Medical Center (CAMC) —Ronceverte, WV
The Care Coordinator supports the primary/specialty care physicians in population health management by focusing care coordination attention on the high to…
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Care Manager

Appalachian Regional Healthcare, Inc. -
Beckley, WV

Apply Now

Job Details

Full-time
3 days ago

Qualifications

RN License
Computer literacy
LPN

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

Associate's Degree Registered Nurse (licensed in state of employment) from an accredited school for nursing Preferred
Bachelor's Degree Nurisng; Must be obtained within 5 years Preferred
4-6 years 5 Years of nursing experience may be considered with demonstration of skills required for the position. Preferred
Advanced knowledge of problem solving and decision making skills.
Strong multi-tasking abilities with the ability to handle competing deadlines; flexible and adaptable.
Ability to deal tactfully with customers and community.
Advanced communication skills used to lead a team.
Advanced execution and delivery (planning, delivering, and supporting) skills.
Ability to consider the relative costs and benefits of potential actions to choose the most appropriate one.
Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
Mastery knowledge of phases of care transitions and resources available for patients.
Mastery of digital literacy skills.
Ability to handle sensitive information ethically and responsibly.
RN Preferred
LPN Required

Apply Now

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utilization review nurse jobs in beckley, wv

Care Manager

Nurse Practitioner (F2F)

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

Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract

Utilization Management Reviewer

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