Top 110 Rn utilization management Jobs in Clinton, Ms

Utilization Management RN SDH
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- Day shift
- Acute care
- Nursing
- RN License
RN - Utilization Review - Utilization Review
The University of Mississippi Medical Center —Jackson, MS
- Full-time
- Nursing
- RN License
- Customer service
Nursing Director - Labor & Delivery
Merit Health Central —Jackson, MS
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
LPN/RN Treatment BAYLOR - Brandon Community Care Center
Mississippi CommCare Corporation —Brandon, MS
- $24 - $25 an hour
- Full-time
- Background check
- CPR Certification
- Skilled nursing facility
Quick Apply
11d
LPN/RN MDS Clinical Care Coordinator - Brandon Community Care Center
Mississippi CommCare Corporation —Brandon, MS
- From $30 an hour
- Full-time
- Background check
- Skilled nursing facility
- Current TB test
Quick Apply
RN Ambulatory - Urogynecology - Mirror Lake
Healthier Mississippi People LLC —Flowood, MS
- RN License
- Customer service
- Mid-level
Experienced Case Manager RN - Case Management (Full Time, Days)
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- Full-time
- Nursing
- RN License
- Hospital
Experienced Case Manager - RN PRN Premium
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- PRN
- Nursing
- RN License
- Hospital
RN I - Sanderson Specialty Clinic
Healthier Mississippi People LLC —Jackson, MS
- Nursing
- RN License
- Customer service
RN - Ambulatory
Healthier Mississippi People LLC —Jackson, MS
- RN License
- Customer service
- Mid-level
RN Ambulatory Ortho Clinic
Healthier Mississippi People LLC —Ridgeland, MS
- RN License
- Customer service
- Mid-level
RN Patient Flow Coordinator-Discharge Lounge
The University of Mississippi Medical Center —Jackson, MS
- Full-time
- RN License
- Inpatient
- Travel
6d
Experienced Case Manager - RN
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- Day shift
- Nursing
- RN License
- Hospital
Quick Apply
Senior Clinical Compliance Auditor
Blue Cross & Blue Shield of Mississippi —Flowood, MS
- Full-time
- Nursing
- RN License
- Mid-level
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Jackson, MS
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
RN Dermatology - Face & Skin Center
Healthier Mississippi People LLC —Jackson, MS
- RN License
- Customer service
- Mid-level
4d
Supervisor Case Management - RN
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- Day shift
- RN License
- 5 years
- BLS Certification
RN - Ambulatory Ortho Clinic
The University of Mississippi Medical Center —Jackson, MS
- Full-time
- Nursing
- RN License
- Customer service
Clinical Documentation Specialist II - Revenue Cycle
The University of Mississippi Medical Center —Clinton, MS
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Clinical Documentation Improvement Specialist
The University of Mississippi Medical Center —Jackson, MS
- Full-time
- Microsoft Excel
- Microsoft Outlook
- RN License

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Utilization Management RN SDH

Franciscan Missionaries of Our Lady Health System -
Jackson, MS

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Job Details

Qualifications

RN License

Full Job Description

Under broad direction from the Centralized Utilization Management Manager, is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves infant, pediatric, adolescent, young adult, adult and geriatric patients. Incumbent of this position is responsible for planning, developing, implementing and monitoring these facility-wide programs. Responsible to ensure cost effective and quality patient care by appropriate utilization of hospital resources. Performs highly responsible professional nursing and administrative work in accordance with established standards, criteria, procedures, rules, regulations and policies. of the agency. Actively communicates with department heads to ensure compliance with these standards.

Team 30%
a. Completes all job requirements related to prospective, concurrent and retrospective case review and reporting quality issues identified during the utilization review process to department leaders.
b. Notifies physicians of need for additional documentation or adjustments to treatment plan to promote continuum of care.
c. Communicates accurate information with payor and physician to ensure coverage for services/care provided.
d. Collaborates with market staff and physicians to optimize efficiency of services provided and minimize consumption of resources.
e. Triages concurrent denials for potential P2P opportunities.
f. Collaborates with facility-based physicians, Physician Advisors, and/or FMOLHS medical directors to schedule and conduct P2P calls by providing key documentation to support the admission status and post-acute placement.
g. Collaborates with Centralized Denials Management Department to coordinated appeal efforts to secure claim reimbursed on services provided.

Service 30%
a. Performs admission review for appropriateness using established Internal criteria within 24 hours of admission/next working day.
b. Assesses patients for needs on initial and concurrent review.
c. Notifies all involved entities when admission fails to meet criteria for admission and immediately documents information.
c. Assists physicians with additional documentation when patients' level of care changes. Immediately notifies key stakeholders to ensure the appropriate orders are obtained and timely notifications are submitted.
d. Monitors care/services provided to assigned patient population for potential opportunities for improvement or possible deviation from standards of care, protocols, and/or completion of core measure pathways.
e. Oversees and takes day-to-day responsibility for effectiveness and efficiency of utilization management function.

Quality 30%
a. Ensures that appropriate priority is given to provide high quality care by ensuring guidelines are followed for core measures through concurrent chart review and follow-up with appropriate healthcare provider.
b. Communicates as needed with the utilization management physician advisors and/or medical directors on problematic cases and documents his decisions.
c. Fosters an organizational climate that supports and promotes effective performance improvement efforts.
d. Promptly notifies Sr. Director or Manager of possible quality issues.
e. Employee shall conform to regulatory, customer and organizational requirements.

Other Duties as assigned 10%
a. Initiates formal Appeals on any Denial for Inpatient Setting when indicated.
b. When requested, adjusts personal schedule to meet department/unit needs.
c. Maintains a professional appearance, according to job requirements, at all times participating in committees or counsels as needed

Experience: 2 years clinical experience in general or specialty Nursing practice. UM/CM Experience preferred.

Education: Graduated from an accredited school of nursing ADN or BSN.

Licensure: Registered Nurse (Active Louisiana, Mississippi, multistate/compact or APRN) required.

Apply Now

Refine Your Search

rn utilization management jobs in clinton, ms

Utilization Management RN SDH

RN - Utilization Review - Utilization Review

Nursing Director - Labor & Delivery

LPN/RN Treatment BAYLOR - Brandon Community Care Center

LPN/RN MDS Clinical Care Coordinator - Brandon Community Care Center

RN Ambulatory - Urogynecology - Mirror Lake

Experienced Case Manager RN - Case Management (Full Time, Days)

Experienced Case Manager - RN PRN Premium

RN I - Sanderson Specialty Clinic

RN - Ambulatory

RN Ambulatory Ortho Clinic

RN Patient Flow Coordinator-Discharge Lounge

Experienced Case Manager - RN

Senior Clinical Compliance Auditor

Case Manager, Registered Nurse (Oncology experience required)

RN Dermatology - Face & Skin Center

Supervisor Case Management - RN

RN - Ambulatory Ortho Clinic

Clinical Documentation Specialist II - Revenue Cycle

Clinical Documentation Improvement Specialist

I want to receive the latest job alert for rn utilization management in clinton, ms

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